Tension gastrothorax in late-presenting congenital diaphragmatic hernia: a diagnostic dilemma.

Abstract

Background: Tension gastrothorax is a rare life-threatening condition that occurs when the stomach is herniated into the thoracic cavity, most often through the congenital left posterolateral diaphragmatic defect, causing a mediastinal shift when distended with gas and fluid.

Case presentation: A previously healthy 2-year-old boy was admitted with acute abdominal pain, vomiting and dyspnea. Chest X-ray was initially interpreted as hydropneumothorax, but after careful observation the decision was made to insert a nasogastric tube and to perform a computerized tomography scan to confirm the suspicion of tension gastrothorax. Laparotomy was performed the following day, organs were repositioned into the abdomen and reconstruction of the left hemidiaphragm was conducted.

Conclusion: When symptoms of respiratory distress occur in an otherwise healthy child, tension gastrothorax should be on the list of differential diagnosis. It is important to recognize distinct radiographic features of this life-threatening condition in order to promptly manage it. Initial placement of nasogastric tube for decompression should be followed by the reduction of the organs into the abdomen and diaphragmatic repair.