Tension Gastrothorax

Q: What is Tension Gastrothorax?

Answer: Patients with self-ventilating diaphragmatic injury or defect (negative pressure ventilation) may sometimes have abdominal content, mostly stomach to herniate (pull) in the chest. It may appear as pneumothorax on CXR due to distended trap air. It occurs in children due to congenital diaphragmatic injury, and in adults, it occurs after trauma.

It can be fatal. Acute management includes placing a Nasogastric(NG) tube or positive pressure ventilation. Also, needle decompression has been described.

#trauma

References:

1. Horst M, Sacher P, Molz G, Willi UV, Meuli M. Tension gastrothorax. J Pediatr Surg. 2005 Sep;40(9):1500-4. doi: 10.1016/j.jpedsurg.2005.05.079. PMID: 16150360. 

2. Næss PA, Wiborg J, Kjellevold K, Gaarder C. Tension gastrothorax: acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children. Scand J Trauma Resusc Emerg Med. 2015 Jun 24;23:49. doi: 10.1186/s13049-015-0129-8. PMID: 26104782; PMCID: PMC4477604.

3. Miyahara M, Kondo N, Sugiyama T, Matsumura Y. Resuscitation from Cardiac Arrest with Tension Gastrothorax Due to Acquired Diaphragmatic Hernia. Am J Emerg Med. 2022 Oct;60:229.e1-229.e3. doi: 10.1016/j.ajem.2022.07.054. Epub 2022 Jul 31. PMID: 35961833.