Combined laparoscopic and thoracoscopic approach for tension gastrothorax in a foramen of Bochdalek hernia
| Autor: | Ajay H. Bhandarwar, Saurabh Gandhi, Eham Arora, Amol Wagh, Nidhisha Sadhwani, Chintan Patel |
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| Rok vydání: | 2019 |
| Předmět: |
musculoskeletal diseases
Thorax medicine.medical_specialty Decompression Bochdalek hernia Borchardt’s triad Article Tension gastrothorax 03 medical and health sciences 0302 clinical medicine medicine Thoracoscopy Gastric volvulus Laparoscopy medicine.diagnostic_test business.industry medicine.disease Hemothorax Empyema Surgery 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology business |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2019.10.076 |
| Popis: | Highlights • Combined laparoscopy and thoracospy to be used in tension gastrothorax. • Minimally invasive approach to be used even in an emergency. • Invasive pre-operative decompression to be avoided. Introduction The incidence of Bochdalek hernias in adults is much more than previously reported. Though most of these are asymptomatic. Tension gastrothorax is a rare complication of these. Literature about the endoscopic management of a tension gastrothorax is extremely sparse. In this case report, we describe how we combined laparoscopy and thoracoscopy in an emergency setting to manage a case of tension gastrothorax with an underlying Bochdalek hernia defect in an adult. Patient profile A 27 year old male presented to our emergency with tension gastrothorax and a gastric volvulus with an underlying Bochdalek hernia defect, exhibiting the classical Borchardt’s triad. The patient underwent an emergency surgery, through a minimally invasive approach wherein the herniated contents were reduced, the gastric volvulus detorted and a repair of the diaphragmatic defect was performed. His post-operative course was uneventful. Discussion Tension gastrothorax, is a diagnostic challenge as an air-fluid level in the thorax on radiology with worsening respiration causes as many as 38% of these cases to be misdiagnosed as tension pneumothorax, hydro-pneumothorax, hemothorax, empyema, effusion or pneumonia. Various techniques of decompression have been described in literature but, employing those, in case of a misdiagnosis may have catastrophic outcomes. Conclusion We strongly recommend employing a combined laparoscopic and thoracoscopic approach for an emergency repair of a tension gastrothorax in a hemodynamically stable patient as, it poses all the advantages of minimal access surgery and is available, at smaller centres, even in an emergency. |
| Databáze: | OpenAIRE |
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