UMEM Educational Pearls

Category: Critical Care

Title: Tension Gastrothorax?

Keywords: gastrothorax, pneumothorax (PubMed Search)

Posted: 10/8/2008 by Mike Winters, MD (Updated: 8/11/2020)
Click here to contact Mike Winters, MD

Tension gastrothorax?

  • Tension gastrothorax is a life threatening condition characterized by herniation of the stomach through a defect in the diaphragm with compression of the mediastinal contents
  • Although many cases occur in pediatric patients (secondary to congenital defects), adults with a history of diaphragmatic injury are at risk (also patients with a type III or IV hiatal hernia)
  • The clinical presentation is the same as a tension pneumothorax - hypotension, tachycardia, hypoxia, JVD, and decreased breath sounds
  • CXR appearance can be very similar to tension pneumothorax, however, the treatment is substantially different
  • Needle decompression and tube thoracostomy are contraindicated, as this may cause visceral perforation
  • The treatment of choice is NGT (or OGT) decompression followed by surgical repair

References

Patton J, Gonzales J, Dillard TA, Szerlip HM. Chest 2008;134:872-5.