A survival case of tension gastrothorax due to hiatal hernia, the key of life-saving is thoracotomy: a case report and review of literature

Abstract Hiatal hernia is a disease that is encountered frequently in the clinic, but the symptoms are variable, from asymptomatic to lethal complications. We describe a case of tension gastrothorax due to esophageal hiatal hernia. The patient was successfully resuscitated from cardiopulmonary arrest by emergency thoracotomy. The patient was a 60-year-old man who had a recurrence of hiatal hernia. He was transferred to emergency department in a shock state, and he quickly went into cardiac arrest. After successful resuscitation, we diagnosed him with tension gastrothorax based on the findings of the physical examination and X-ray. We attempted to insert a nasogastric tube (NGT) but failed because of the obstruction of the lower esophagus, so we performed an emergency operation. First, we performed laparotomy, but it was difficult to return the hernia contents into the abdominal cavity because of the incarceration. Because he went into cardiac arrest again, we opened the thorax and started open cardiac massage. At the same time, we inserted a NGT to the stomach wall directly for decompression and achieved successful resuscitation afterward. Subsequently, the abdominal contents in the thorax were restored to their normal anatomical position, and the stomach wall and hiatus hernia were repaired. After the operation, he received hypothermia therapy and he exhibited no complications or neurological sequelae. He was discharged on the 22nd postoperative day. Tension gastrothorax is a rare but life-threatening situation, and emergency physicians have to be aware of this pathology and should not hesitate to perform an emergent decompression by thoracotomy.