TENSION GASTROTHORAX: OCCULT CHILDHOOD DIAPHRAGMATIC INJURY PRESENTING AS ACUTE EMERGENCY IN PREGNANCY
Abstract
We present a case of tension gastrothorax in a 27-year-old primigravida with the complaints of
respiratory distress. She was hypoxic and tachycardiac. The left thorax was resonant to percussion and
had no air entry. Chest X-ray was not helpful to reach the diagnosis. Later on, the tracheal deviation
was noted and thoracostomy was done. The patient aborted overnight. Greenish fluid in the chest
drain led to an investigation with computed tomography which revealed massive viscerothorax. Review
of her history revealed that she had a blunt abdominal injury as a child. Laparotomy confirmed the
above findings along with a gastric perforation. Diaphragm and stomach were repaired,
gastropexy and caecopexy was done. Occult diaphragmatic injury can complicate the pregnancy.
High intra-abdominal pressure during the pregnancy can push much of abdominal contents
through the diaphragmatic defect. Creation of angulation at gastroesophageal junction acts as a
one-way valve and thus leads to progressive dilation of the stomach, resulting in tension
gastrothorax.