An Unusual Case of Acute Dyspnoea: Acute Intrathoracic Gastric Volvulus with Probable Tension Gastrothorax

Abstract

Acute gastric volvulus is a rare complication affecting 4% of hiatal hernias. It is described as an abnormal rotation of the stomach around a transverse or longitudinal axis and can be intra-abdominal or intrathoracic. Intrathoracic gastric volvulus can lead to tension gastrothorax, which is defined as the presence of a massive gastric distension in the chest cavity causing a mediastinal shift with haemodynamic instability and a risk of cardiorespiratory arrest. We report a case of intrathoracic gastric volvulus with probable tension gastrothorax. Early diagnosis of gastrothorax with computed tomography and immediate insertion of a nasogastric tube resulted in rapid clinical improvement. Surgical intervention is the treatment of choice.

Learning points: Tension gastrothorax should be suspected in the presence of abdominal and chest pain, vomiting and haemodynamic instability.Prompt diagnosis and treatment are necessary to reduce morbidity and mortality.

Keywords: Volvulus gastric; gastrothorax; hiatal hernia.

Figure 1

CT scan (portal phase in the sagittal view) showing a hiatal hernia (red line) with intussusception of the intrathoracic part (star)

Figure 2

CT scan (portal phase in the coronal view) showing the hiatal hernia with intussusception of the thoracic part of the stomach (delimited by the dotted line). Gastric pneumatosis in the thoracic and abdominal parts of the stomach is indicated by arrowheads

Figure 3

CT scan (transverse axial section) with intravenous contrast. The star indicates the hiatal hernia caused by twisting of the stomach complicated by gastric invagination. The oesophagus, marked with a yellow triangle, is adjacent to the intrathoracic stomach