The need to suspect tension gastrothorax as a cause of obstructive shock in trauma care: A case report

• Published in: International journal of surgery case reports Vol. 118; p. 109612
• Main Authors: Shinjo, Takafumi, Tanaka, Yasutaka, Izawa, Yoshimitsu, Yonekawa, Chikara, Matsumura, Tomohiro, Mato, Takashi
• Format: Report
• Language: English
• Published: 01.05.2024
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109612

INTRODUCTIONTraumatic tension gastrothorax is a type of obstructive shock similar to tension pneumothorax. However, tension gastrothorax is not well known among emergency physicians, and no consensus has yet been reached on management during initial trauma care. We present a case of traumatic tension gastrothorax in which tube thoracostomy was performed based solely on clinical findings very similar to tension pneumothorax, followed by emergency laparotomy.PRESENTATION OF CASEA 24-year-old male motorcyclist was brought to our emergency medical center after being struck by a motor vehicle. He was in respiratory failure and hypotensive shock with findings suggestive of pneumothorax. Although the physical findings were not fully in line with tension pneumothorax, we immediately performed finger thoracostomy. Subsequent radiography revealed left diaphragmatic rupture with hernia. After unsuccessful attempts to decompress the stomach with a nasogastric tube, immediate emergency laparotomy was performed. During the operation, the stomach, which had prolapsed through the ruptured diaphragm into the thoracic cavity, was manually returned to the abdominal cavity. The ruptured diaphragm was repaired with sutures.DISCUSSIONAlthough distinguishing between tension pneumothorax and tension gastrothorax based on physical examination alone is difficult, tension gastrothorax requires careful attention to avoid intrapleural contamination from gastric injury. In addition, relying solely on stomach decompression with a nasogastric tube or delaying laparotomy could lead to cardiac arrest.CONCLUSIONWhen tension pneumothorax is suspected during initial trauma care, tension gastrothorax should also be considered as a differential diagnosis and treated with immediate diaphragmatic repair once identified.