Wickramasinghe S, Ruggiero B, Low L. Gastrothorax: A case of mistaken identity.
Int J Surg Case Rep 2018;
44:66-69. [PMID:
29477923 PMCID:
PMC5835008 DOI:
10.1016/j.ijscr.2018.02.022]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
Patients with a recent history of anti-reflux surgery, who present with a tension pneumothorax could be presenting with a gastrothorax.
They should always be treated with an intercostal catheter if they are in respiratory distress.
Follow up imaging with a CT scan is needed to confirm diagnosis.
Gastrothorax should be urgently managed with the insertion of a nasogastric tube and surgical decompression.
Good control of post- operative nausea and vomiting is essential in avoiding wrap failure and ensuing complications.
Introduction
Acute wrap failure post fundoplication is a rare but recognized complication and can be due to patient factors, disease factors and surgical factors. Herniation of the stomach into the thorax can mimic a pneumothorax clinically and radiologically and thus lead to bad outcomes for patients.
Presentation of case
We report the case of a 20-year-old male who presented to the emergency department with progressively worsening upper abdominal pain, nausea and vomiting followed by acute onset dyspnoea, six days post a laparoscopic repair of a small hiatus hernia and a Nissen fundoplication. His chest x-ray was consistent with that of a left sided pneumothorax and was therefore, appropriately resuscitated and treated with an intercostal catheter (ICC). A subsequent CT scan of the chest revealed a left gastrothorax. The patient was taken to theatre for the surgical reduction of the paraoesophageal hernia.
Discussion
Patients with a recent history of anti-reflux surgery, who present with a pneumothorax and respiratory distress or a tension pneumothorax should always be treated with an ICC. However, follow up imaging with a CT scan is essential to confirm diagnosis. Good control of post- operative nausea and vomiting is essential in avoiding wrap failure and ensuing complications.
Conclusion
A high index of suspicion for a gastrothorax mimicking a pneumothorax is important in the setting of recent anti-reflux surgery.
Collapse