An intragastric chest tube insertion

A 38-year-old man presented with a 1-week history of respiratory distress and abdominal pain with vomiting. He had undergone left lower lobectomy for localized bronchiectasis 6 months earlier. Physical examination revealed unilateral distension of the left thorax with hyperresonance to percussion and absent breath sounds suggestive of left tension pneumothorax. He rapidly presented cardiopulmonary arrest. Early resuscitation was provided but needle aspiration was unsuccessful. Return to spontaneous cardiac activity was obtained after left chest tube insertion and pleural drainage of 1,000 ml of brown fluid and gas. A chest radiograph (Fig. 1) performed before cardiac arrest showed air and liquid in the left pleural cavity with severe deviation of mediastinal structures and right lung compression. A CT-scan (Fig. 2) of the chest revealed herniation of the stomach into the left chest cavity and insertion of the chest tube into the lumen of the intrathoracic stomach. An urgent surgical procedure established the diagnosis of acquired diaphragmatic hernia with intrathoracic gastric volvulus. Perioperative findings confirmed gastric placement of the tube with its trans-diaphragmatic route until the duodenal lumen. Surgery consisted of replacing the stomach back into the abdomen, suturing the iatrogenic gastric perforation, and repairing the diaphragm.