title: How to manage tension gastrothorax: a case report of tension gastrothorax with multiple trauma due to traumatic diaphragmatic rupture.
abstract: BACKGROUND
  Tension gastrothorax is a kind of obstructive shock with prolapse and distention of the stomach into the thoracic cavity. Progressive gastric distension leads to mediastinal shift, reduced venous return, decreased cardiac output, and ultimately cardiac arrest. Therefore, it is crucial to decompress the stomach distension for the initial resuscitation of tension gastrothorax.
  
  
  METHODS
  A 75-year-old female was transported to our resuscitation bay due to motor vehicle crash. At the time of arrival to our hospital, the patient developed cardiac arrest. While undergoing cardiopulmonary resuscitation, an unstable pelvic ring was recognized, so we performed a resuscitative thoracotomy to control hemorrhage and to perform direct cardiac massage. Once we performed the thoracotomy, the stomach and omentum prolapsed out of the thoracotomy site and through the diaphragm rupture site and spontaneous circulation was recovered. Neither the descending aorta nor the heart was collapsed. Although we had continued the treatment for severe pelvic fracture (including blood transufusions), the patient died. Given that (1) the stomach prolapsed out of the body at the time of the thoracotomy; (2) at the same timing, spontaneous circulation returned; and (3) the descending aorta and heart did not collapse, we hypothesized that the main cause of the initial cardiac arrest was tension gastrothorax.
  
  
  CONCLUSIONS
  Recognition of tension gastrothorax pathophysiology, which is a form of obstructive shock, makes it possible to manage this injury correctly.
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan. naobun1221@gmail.com.
authors.forename: Naofumi
authors.identifier: http://orcid.org/0000-0003-3605-402X
authors.initials: N
authors.lastname: Bunya
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Sawamoto
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Uemura
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyohara
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Yukino
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Kyan
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Miyata
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Hideto
authors.initials: H
authors.lastname: Irifune
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Harada
authors.affiliation: Department Emergency Medicine, Sapporo Medical University, S1W16 Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Eichi
authors.initials: E
authors.lastname: Narimatsu
keywords: Obstructive shock; REBOA; Resuscitative thoracotomy; Tension gastrothorax