Display options
Cite
Wickramasinghe S, Ruggiero B, Low L. Gastrothorax: A case of mistaken identity. Int J Surg Case Rep. 2018;44:66-69doi: 10.1016/j.ijscr.2018.02.022.
Wickramasinghe, S., Ruggiero, B., & Low, L. (2018). Gastrothorax: A case of mistaken identity. International journal of surgery case reports, 4466-69. https://doi.org/10.1016/j.ijscr.2018.02.022
Wickramasinghe, Shehan, et al. "Gastrothorax: A case of mistaken identity." International journal of surgery case reports vol. 44 (2018): 66-69. doi: https://doi.org/10.1016/j.ijscr.2018.02.022
Wickramasinghe S, Ruggiero B, Low L. Gastrothorax: A case of mistaken identity. Int J Surg Case Rep. 2018;44:66-69. doi: 10.1016/j.ijscr.2018.02.022. Epub 2018 Feb 17. PMID: 29477923; PMCID: PMC5835008.
Copy Download .nbib Format: NLM
Share it on

Int J Surg Case Rep. 2018;44:66-69. doi: 10.1016/j.ijscr.2018.02.022. Epub 2018 Feb 17.

Gastrothorax: A case of mistaken identity.

International journal of surgery case reports

Shehan Wickramasinghe, Boris Ruggiero, Liang Low

Affiliations

  1. Upper Gastrointestinal and Hepatobiliary Surgical Unit, Monash Health, 246 Clayton Road, Victoria 3168, Australia. Electronic address: [email protected].
  2. Upper Gastrointestinal and Hepatobiliary Surgical Unit, Monash Health, 246 Clayton Road, Victoria 3168, Australia.

PMID: 29477923 PMCID: PMC5835008 DOI: 10.1016/j.ijscr.2018.02.022

Abstract

INTRODUCTION: Acute wrap failure post fundoplication is a rare but recognized complication and can be due to patient factors, disease factors and surgical factors. Herniation of the stomach into the thorax can mimic a pneumothorax clinically and radiologically and thus lead to bad outcomes for patients.

PRESENTATION OF CASE: We report the case of a 20-year-old male who presented to the emergency department with progressively worsening upper abdominal pain, nausea and vomiting followed by acute onset dyspnoea, six days post a laparoscopic repair of a small hiatus hernia and a Nissen fundoplication. His chest x-ray was consistent with that of a left sided pneumothorax and was therefore, appropriately resuscitated and treated with an intercostal catheter (ICC). A subsequent CT scan of the chest revealed a left gastrothorax. The patient was taken to theatre for the surgical reduction of the paraoesophageal hernia.

DISCUSSION: Patients with a recent history of anti-reflux surgery, who present with a pneumothorax and respiratory distress or a tension pneumothorax should always be treated with an ICC. However, follow up imaging with a CT scan is essential to confirm diagnosis. Good control of post- operative nausea and vomiting is essential in avoiding wrap failure and ensuing complications.

CONCLUSION: A high index of suspicion for a gastrothorax mimicking a pneumothorax is important in the setting of recent anti-reflux surgery.

Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Keywords: Anti-reflux surgery; Case report; Complications; Gastrothorax; Nissen fundoplication; Pneumothorax

References

  1. Ann Surg. 2000 Oct;232(4):608-18 - PubMed
  2. Surg Endosc. 2018 Feb;32(2):937-944 - PubMed
  3. Frontline Gastroenterol. 2014 Oct;5(4):272-276 - PubMed
  4. J Gastrointest Surg. 2018 Feb;22(2):371-373 - PubMed
  5. ANZ J Surg. 2011 Apr;81(4):246-52 - PubMed
  6. Am J Emerg Med. 2007 Feb;25(2):226-8 - PubMed
  7. Br J Surg. 1995 Apr;82(4):521-3 - PubMed
  8. J Anaesthesiol Clin Pharmacol. 2011 Jul;27(3):373-6 - PubMed
  9. J Surg Case Rep. 2010 Aug 01;2010(6):5 - PubMed
  10. Am J Emerg Med. 2007 Jul;25(6):734.e5-6 - PubMed
  11. J Pediatr Surg. 2005 Mar;40(3):586-7 - PubMed
  12. Int J Surg Case Rep. 2017;31:180-183 - PubMed
  13. Int J Surg. 2016 Oct;34:180-186 - PubMed
  14. Am J Surg. 2004 Dec;188(6):786-91 - PubMed
  15. BMJ Case Rep. 2017 Jul 27;2017: - PubMed
  16. Anaesth Intensive Care. 2011 Nov;39(6):1120-3 - PubMed
  17. Cases J. 2009 Jun 09;2:7514 - PubMed
  18. Anaesthesia. 2002 Aug;57(8):828-30 - PubMed

Publication Types