Tension gastrothorax complicating acute traumatic diaphragmatic rupture

Herniation of abdominal viscera into the thorax following traumatic diaphragmatic hernia can simulate acute tension pneumothorax. A case is presented of a blunt trauma victim with apparent acute diaphragmatic rupture, tension hemothorax, or tension hemopneumothorax. Nasogastric tube insertion demonstrated tension gastrothorax, but was followed by acute clinical decompensation. Percutaneous needle thoracostomy decompressed the stomach without causing spillage of gastric contents. Autopsy experimentation was performed to demonstrate that needle decompression of the distended stomach is well tolerated. Tension gastrothorax is a rare, life-threatening complication of traumatic diaphragmatic hernia. Although nasogastric tube placement should be attempted first, it may exacerbate the condition. Percutaneous needle decompression of the stomach through the chest wall can stabilize the situation and is safer and more rapid than chest tube placement, which might be either ineffective or dangerous. Paralyzing the patient with acute diaphragmatic rupture before tracheal and gastric intubation might prevent progression to tension gastrothorax.