Tension gastrothorax in late-onset congenital diaphragmatic hernia, a rare but life-threatening condition: A case report

RATIONALE: Tension gastrothorax is a serious condition that can cause acute respiratory failure, which is mostly related to congenital diaphragmatic hernia (CDH) in pediatric cases. It is uncommon in late-onset CDH patients, and is difficult to diagnose due to atypical presentation. It is often misdiagnosed as tension pneumothorax or pleural effusion, leading to delayed treatment and potentially fatal outcome. In this study, we are reporting our experience of diagnosis and treatment of tension gastrothorax in a late-onset CDH patient. PATIENT CONCERNS: A 2-year old boy presented to this hospital with severe dyspnea and abdominal pain that suddenly occurred while taking a bath. DIAGNOSIS: Based on radiological findings we diagnosed tension gastrothorax. INTERVENTIONS: Hernia reduction and diaphragmatic defect repair were performed under thoracotomy. OUTCOMES: After the operation, the patient's clinical symptoms and imaging findings improved. At 1-year postoperative follow up, the patient was well with normal chest x-ray findings. LESSONS: Tension gastrothorax in late-onset CDH is a life-threatening condition that requires rapid diagnosis and treatment. When the diagnosis is unclear by chest x-ray, chest computed tomography should be performed to confirm the diagnosis. A nasogastric tube should be inserted whenever possible for diagnosis and gastric decompression. Although laparotomy is the most preferred approach, we recommend that surgeons consider taking a thoracotomy approach in unstable patients that cannot undergo gastric decompression before operation.