title: Tension gastrothorax.
abstract: BACKGROUND
  Tension gastrothorax develops when the stomach herniated through a congenital diaphragmatic defect into the thorax is massively distended by trapped air. The authors present 5 cases and discuss the diagnostic and therapeutic management.
  
  
  METHODS
  Four children, aged 3, 4, 6, and 13 months, presented with progressive respiratory distress. In only 1 child was the diagnosis of tension gastrothorax established initially, and immediate insertion of a nasogastric tube led to complete resolution of respiratory distress symptoms. In the remaining 3 children, the initial chest radiograph was misread as tension pneumothorax. One of them developed cardiac arrest and was successfully resuscitated. In 2 patients, thoracostomy resulted in immediate respiratory improvement. Only on follow-up radiographic evaluation was diaphragmatic hernia with herniation of the stomach into the left hemithorax diagnosed. One child underwent diagnostic thoracoscopy revealing the correct diagnosis. All 4 children underwent uneventful repair of a classic Bochdalek hernia. The fifth child, aged 5 months, had sudden infant death. At autopsy tension gastrothorax was found.
  
  
  CONCLUSIONS
  Tension gastrothorax is a life-threatening condition leading to acute and severe respiratory distress. The condition exhibits distinct radiographic features. Emergency decompression of the distended stomach should first be attempted via nasogastric tube. If this maneuver fails, decompression must be achieved either by needle puncture or by chest tube insertion into the stomach.
authors.affiliation: Department of Surgery, University Children's Hospital, CH-8032 Zurich, Switzerland.
authors.forename: Maya
authors.initials: M
authors.lastname: Horst
authors.forename: Peter
authors.initials: P
authors.lastname: Sacher
authors.forename: Gisela
authors.initials: G
authors.lastname: Molz
authors.forename: Ulrich Victor
authors.initials: UV
authors.lastname: Willi
authors.forename: Martin
authors.initials: M
authors.lastname: Meuli
mesh_terms: D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D012120:Respiration Disorders / Q000209:etiology; D013270:Stomach / Q000473:pathology* / Q000601:surgery*; D013909:Thorax / Q000473:pathology*