title: Management of acute gastrothorax with respiratory distress: insertion of nasogastric tube as a life saving procedure.
abstract: An 86-year-old patient was transferred to our institution with acute respiratory distress. A tension pneumothorax was suspected, but needle decompression was unsuccessful. Instead of the suspected pneumothorax, the chest radiograph revealed a large 'tension gastrothorax'. In a matter of seconds, the insertion of a nasogastric tube resulted in drastic improvement of the critical clinical state. Acute tension gastrothorax is a rare, but classic, complication of paraoesophageal hernias. Its clinical presentation can be dramatic and rapidly lethal, immediate action is therefore warranted. Nasograstric tube insertion is a life saving procedure to be undertaken without delay. However, tension gastrothorax is a rare entity. Therefore, if tension pneumothorax is suspected, needle decompression should not be delayed.
authors.affiliation: Surgery Department, Neuchâtelois Hospital, Neuchâtel, Switzerland. dan.azagury@ne.ch
authors.forename: Dan E
authors.initials: DE
authors.lastname: Azagury
authors.forename: Wolfram
authors.initials: W
authors.lastname: Karenovics
authors.forename: Dominique M
authors.initials: DM
authors.lastname: Stähli
authors.forename: Jérôme
authors.initials: J
authors.lastname: Mathis
authors.forename: Rémi
authors.initials: R
authors.lastname: Schneider
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods*; D003964:Diaphragm / Q000473:pathology*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007441:Intubation, Gastrointestinal; D009339:Needles; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000601:surgery / Q000628:therapy*