Related Experiment Video
Updated: Aug 16, 2026
Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
Published on: September 20, 2024
Tension gastrothorax
Maya Horst1, Peter Sacher, Gisela Molz
1Department of Surgery, University Children's Hospital, CH-8032 Zurich, Switzerland.
Insights
Tension gastrothorax, a life-threatening condition, causes severe respiratory distress in infants due to stomach distension in the chest. Prompt diagnosis and gastric decompression are crucial for survival.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Tension gastrothorax occurs when a stomach herniates through a congenital diaphragmatic defect and becomes distended with air.
- This condition leads to acute, severe respiratory distress in infants.
Observation:
- Five pediatric cases of tension gastrothorax are presented, highlighting diagnostic and therapeutic challenges.
- Misinterpretation of chest radiographs as tension pneumothorax occurred in three cases, delaying diagnosis and treatment.
- One infant experienced cardiac arrest, requiring resuscitation, while two improved with thoracostomy.
Findings:
- Tension gastrothorax presents with distinct radiographic features, often initially misdiagnosed.
- Successful initial management involved nasogastric tube insertion for gastric decompression.
- Surgical repair of Bochdalek hernia was performed in four children with favorable outcomes.
Implications:
- Early recognition and emergency gastric decompression are vital for managing tension gastrothorax.
- Nasogastric tube insertion is the primary method for decompression; needle puncture or chest tube insertion are alternatives if initial measures fail.
- Accurate radiographic interpretation and timely intervention can prevent severe complications and mortality.
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.
Case Reports:
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.
Conclusion:
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.
Related Concept Videos
01:08Pneumothorax II: Pathophysiology
01:26Pneumothorax-I
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
01:27Pneumothorax-II
Clinical Manifestations:
01:25Muscles of the Thorax
The diaphragm is at the core of thoracic musculature, the primary muscle involved in breathing. This expansive, dome-shaped muscle marks the division between the thoracic and abdominal cavities. It originates...
01:17The Thoracic Cage: Sternum
The sternum is the elongated bony structure on the anterior side of the thoracic cage. It consists of three parts: the manubrium, the body, and the xiphoid process.
01:25Hiatal Hernia