Never seen right gastrothorax: A case report

Abstract

Traumatic gastrothorax, or stomach herniation into the chest post-trauma, is a rare but dangerous condition that can lead to respiratory distress and obstructive shock. Its diagnosis is challenging and requires a high index of suspicion. Immediate stomach decompression is an important, often life-saving step of the treatment, prior to definitive surgical repair. We report herein the case of a 59 year-old female patient, who was involved in a severe motor vehicle accident resulting in multiple injuries. Her right-sided gastrothorax, manifesting as solely nausea at first, was only diagnosed 16 days after trauma, intraoperatively. Worse, her herniated stomach had ruptured within the right pleural cavity causing pneumothorax, spillage of contents and pleuritis. It was an erroneous radiological diagnosis of right lung necrosis which halted surgical management. Right gastrothorax has never been reported previously. This article also reviews the condition's pathophysiology, along with diagnostic and therapeutic modalities, and sheds light on the importance of its early recognition and treatment.

Keywords: Gastric rupture; Gastrothorax; Right; Trauma.

Fig. 1

Remarkable imaging. A: in-bed chest X-ray on D4; B: chest x-ray on D10; C: computed tomography scan of the chest on D11; D: computed tomography scan of the chest on D14.

Fig. 2

Ruptured stomach being repaired after reduction.

Fig. 3

Coronal views of computed tomography scans. A: D0; B: D1. Right arrow = oesophagus. Yellow arrow = fundus. Blue arrow = collar sign. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)