Open AccessTENSION GASTROTHORAX: OCCULT CHILDHOOD DIAPHRAGMATIC INJURY PRESENTING AS ACUTE EMERGENCY IN PREGNANCY
Author(s) -
Syed Shamshad Hussaina,
Asif Khana,
Farhana Yawarb,
Sardar Alia,
Muhammad Al Skainia,
Abdulelah Hummadia
Publication year - 2018
Publication title -
journal of surgical sciences
Language(s) - English
Resource type - Journals
eISSN - 2457-5364
pISSN - 2360-3038
DOI - 10.33695/jss.v5i3.227
Subject(s) - medicine , occult , surgery , laparotomy , diaphragmatic breathing , diaphragm (acoustics) , exploratory laparotomy , diaphragmatic hernia , thoracostomy , pregnancy , perforation , radiology , hernia , pneumothorax , pathology , physics , alternative medicine , punching , materials science , biology , metallurgy , acoustics , loudspeaker , genetics
We present a case of tension gastrothorax in a 27-year-old primigravida with the complaints ofrespiratory distress. She was hypoxic and tachycardiac. The left thorax was resonant to percussion andhad no air entry. Chest X-ray was not helpful to reach the diagnosis. Later on, the tracheal deviationwas noted and thoracostomy was done. The patient aborted overnight. Greenish fluid in the chestdrain led to an investigation with computed tomography which revealed massive viscerothorax. Reviewof her history revealed that she had a blunt abdominal injury as a child. Laparotomy confirmed theabove 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 contentsthrough the diaphragmatic defect. Creation of angulation at gastroesophageal junction acts as aone-way valve and thus leads to progressive dilation of the stomach, resulting in tensiongastrothorax.