Diagnostic confusion caused by tension gastrothorax – Case series

Mehmet Emin Boleken; Tansel Günendi; Mehmet Çakmak; Veysel Kaya; Osman Hakan Kocaman

doi:10.4103/tjem.tjem_251_23

Mehmet Emin Boleken¹, Tansel Günendi¹, Mehmet Çakmak¹, Veysel Kaya², Osman Hakan Kocaman¹

¹Department of Pediatric Surgery, Harran University Medical Faculty, Şanlıurfa, Turkey
²Department of Radiology, Harran University Medical Faculty, Şanlıurfa, Turkey

Keywords: Congenital diaphragmatic hernias, emergency interventions, respiratory distress, tension gastrothorax, traumatic diaphragmatic hernias

Abstract

The presence of the stomach in the thorax is called gastrothorax. If excessive dilatation occurs due to a valve mechanism in the stomach which then is herniated into the thorax, it is called tension gastrothorax and the situation can be life threatening. In late presentation, congenital diaphragmatic hernias or traumatic diaphragmatic hernias, if the stomach located in the thorax is severely distended, it can be confused with tension pneumothorax or pleural effusion/empyema. We presented tension gastrothorax in two patients with distended stomach in the thorax, in which tension pneumothorax and pleural effusion/empyema like images were created, based on plain X rays taken at the first admission in the emergency department, which may cause diagnostic confusion. The tension gastrothorax can cause mediastinal shift, which can lead to respiratory distress and eventually cardiac arrest secondary to obstructive shock. In case of mediastinal shift, it should reduce the tension of the stomach located in the thorax by inserting a nasogastric catheter, and if this fails, by aspiration with a needle.

How to cite this article: Boleken ME, Günendi T, Çakmak M, Kaya V, Kocaman OH. Diagnostic confusion caused by tension gastrothorax – Case series. Turk J Emerg Med 2024;24:252-4.