Gastrothorax following upper gastrointestinal tract endoscopy

A 27-year-old man presented with vomiting and breathlessness for 1 day, 5 days after upper gastrointestinal tract endoscopy. On admission, the patient was breathless but not cyanosed; he had sinus tachycardia (heart rate 110 beats/min) and was normotensive (blood pressure 120/75 mm Hg). There were signs of mediastinal shift to the right. There were no breath sounds over the left side of the chest but normal breath sounds were heard to the right of the sternum. His chest x ray, CT scan of the chest and a barium meal study revealed gastrothorax. He was operated on and at surgery the stomach and ascending colon were found herniating into the chest through a posterolateral defect of the left hemidiaphragm. These were moved back to the abdomen and the diaphragmatic defect was closed. The patient made an uneventful recovery and remained well when seen in the clinic 2 months following surgery.