Link: http://www.ncbi.nlm.nih.gov/pubmed/25697322

Rev Chil Pediatr. 2014 Jul;85(4):476-80. doi: 10.4067/S0370-41062014000400011.

[Tension gastrothorax as a cause of death by obstructive shock - case report].
[Article in Spanish]

Garcia-Regalado JF, Navarro-Rojas MM.

Abstract

INTRODUCTION:
Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type.

OBJECTIVE:
Tension gastrothorax should be considered as a differential diagnosis in patients with obstructive shock and tension pneumothorax.

CASE REPORT:
A previously healthy 10 month-old male infant, who presented increased respiratory distress, increased volume of the left hemithorax, absence of breath sounds, ipsilateral hyper-resonance, 76% saturation, cold skin and capillary filling > 5 seconds, followed by a cardio-respiratory arrest. Due to clinical suspicion of pneumothorax, needle decompression was performed reversing cardiac arrest, but with persistent hemodynamic and respiratory instability; chest radiograph suggested diaphragmatic hernia. He underwent surgery confirming the presence of a diaphragmatic hernia of 5 cm.

CONCLUSIONS:
The evolution of this case shows the difficulty differentiating a tension gastrothorax from tension pneumothorax in patients admitted to the emergency room who are in serious condition; therefore, a high index of suspicion is needed for its identification.

PMID: 25697322 [PubMed - in process]