Minerva
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3843 (Published 21 September 2009) Cite this as: BMJ 2009;339:b3843
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Gastrothorax is not commonly reported in the literature and there is
no easy search term which will pick up previous reports.
In 1985, we had made the right diagnosis that the stomach had
herniated into the chest in a case (1) and referred the patient for
thoracotomy. She also had a revised diagnosis at the receiving centre and
a chest drain put in which drained stomach contents. She then went onto
emergency thoractomy.
Following a similar case (2) Oliver Pratt (3) commented that
insertion of a chest drain according to ATLS guidelines should be
atraumatic and so accidental draining of the stomach should not occur.
The literature suggests that there is some hurry in reducing the
herniation as the vessels to the stomach are stretched when it lies in the
thorax. We congratulate the team on their successful management and note
the length of time from accident to presentation. The delay from
initiating event to presentation also occurred in our first case.
Oliver Dearlove FRCA
1. Reed M de Silva P Mostafa S Collins F Diaphragmatic hernia in
pregnancy Br Jl Surgery 1987 74 435
2. Ni KM Watts JC Panditaratne, An important differential diagnosis
of pneumothorax Anaesthesia 2002 57 828-30
3. Dearlove O Pratt O Tension Gastrothorax Anaesthesia 2003 58 91-2
Competing interests:
disgustingly on-topic compared to some of the e-responses this week
Competing interests: No competing interests
Emergency management is vital
Lieske et al do not mention a crucial part of the management of this
life threatening condition. A true tension gastrothorax with mediastinal
shift may well produce lethal cardiorespiratory compromise. Pain, fear or
distress may lead to swallowing of air, worsening the problem.This should
be treated as an emergency.
Drainage of the dilated stomach with a nasogastric tube is advised
(1,2,3). Should this fail, insertion of a percutaneous needle into the
intrathoracic portion of the stomach is recommended (1,2) or if no
improvement, a chest tube(1).
We agree with the authors that diagnosis may be confused with a tension
pneumothorax, for which immediate needle drainage followed by tube
thoracostomy is needed.
References
1 Horst M, Sacher P, Molz,G, Willi UV, Meuli M. Tension gastrothorax.
Journal of Paediatric Surgery 2005;40:1500-4.
2 Slater RG. Tension gastrothorax complicating acute traumatic
diaphragmatic rupture. Journal of Emergency Medicine 1992;10:25-30.
3 Snyder HS, Salo DF, Kelly PH. Congenital diaphragmatic hernia
presenting as massive gastrothorax. Annals of Emergency Medicine
1990;19:562-4.
Competing interests:
None declared
Competing interests: No competing interests