Resuscitation from Cardiac Arrest with Tension Gastrothorax Due to Acquired Diaphragmatic Hernia

Tension gastrothorax is a rare cause of obstructive shock induced by a distended stomach herniating into the thorax through a diaphragmatic defect. We report the process of diagnosis and emergency treatment for tension gastrothorax during cardiopulmonary resuscitation (CPR). A 71-year-old woman with...

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Bibliographic Details
Published in:The American journal of emergency medicine 2022-10, Vol.60, p.229-229.e3
Main Authors: Miyahara, Masaya, Kondo, Natsuki, Sugiyama, Takuya, Matsumura, Yosuke
Format: Article
Language:English
Subjects:
Abdomen
Cardiac arrest
Cardiopulmonary resuscitation
Chest
Consciousness
CPR
Decompression
Diagnosis
Diaphragm
Distension
Echocardiography
Emergency medical care
Endoscopy
Hemodynamics
Hernia
Hernias
Mediastinum
Mortality
Nausea
Ostomy
Peritoneum
Pneumothorax
Scars
Stomach
Tension
Trauma
Ultrasonic imaging
Ventricle
Vomiting
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Summary:Tension gastrothorax is a rare cause of obstructive shock induced by a distended stomach herniating into the thorax through a diaphragmatic defect. We report the process of diagnosis and emergency treatment for tension gastrothorax during cardiopulmonary resuscitation (CPR). A 71-year-old woman with multiple surgical histories had nausea and vomiting for two days. She was transferred to our hospital with circulatory failure and loss of consciousness. She presented pulseless electric activity and received CPR immediately after arrival. The right atrium and right ventricle were collapsed in the echocardiography. A chest X-ray demonstrated a dilated intestine extending from the peritoneal cavity to the mediastinum. The nasogastric tube (NGT) drained 1000 mL of stomach content and alleviated the abdominal distension, and spontaneous circulation returned immediately after the drainage. Thoracoabdominal CT showed the stomach and the transverse colon had escaped from the peritoneal cavity to the mediastinum. We diagnosed the situation as tension gastrothorax due to an acquired diaphragmatic hernia. History of multiple surgery and multiple operative scars was the first step of the diagnostic process, and the chest X-ray during CPR was the key to the diagnosis. Tension gastrothorax can be misdiagnosed as other conditions. A chest X-ray should be preceded in non-trauma settings, unlike the setting of a tension pneumothorax in trauma patients. Gastrointestinal decompression with NGT placement could be attempted quickly to improve the hemodynamic condition.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2022.07.054