Ahn Shin, Kim Won, Sohn Chang Hwan, Seo Dong Woo
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Emerg Med. 2012 Dec;43(6):e451-3. doi: 10.1016/j.jemermed.2011.05.084. Epub 2012 Jan 13.
Tension viscerothorax is herniation of abdominal viscera into the thorax. Tension viscerothorax can simulate tension pneumothorax. Immediate decompression with a nasogastric tube is required for hemodynamic stabilization.
A case of tension viscerothorax is reported along with a review of the literature to highlight this rare complication of blunt abdominal trauma, and to emphasize the importance of nasogastric tube decompression in tension viscerothorax.
A 10-year-old boy with a remote history of trauma related to a motor vehicle crash was brought into the Emergency Department with a 3-day history of vomiting, epigastric pain, and dyspnea. By physical examination and chest X-ray study, tension gastrothorax was diagnosed. Nasogastric tube placement was difficult and delayed, and the patient deteriorated into cardiac arrest, but after successful cardiopulmonary resuscitation and nasogastric tube insertion, the patient was stabilized. Laparotomy was performed and primary repair of a ruptured diaphragm was done. The patient made an uneventful recovery.
Acute tension viscerothorax should be considered in the differential diagnosis of tension pneumothorax, and its initial resuscitation should include nasogastric tube insertion for immediate decompression.
张力性内脏胸腔疝是腹腔脏器疝入胸腔。张力性内脏胸腔疝可模拟张力性气胸。为稳定血流动力学，需要立即用鼻胃管减压。
报告一例张力性内脏胸腔疝病例，并复习文献以突出钝性腹部创伤的这种罕见并发症，并强调鼻胃管减压在张力性内脏胸腔疝中的重要性。
一名有机动车碰撞相关既往创伤史的10岁男孩因呕吐、上腹部疼痛和呼吸困难3天被送入急诊科。通过体格检查和胸部X线检查，诊断为张力性胃胸腔疝。鼻胃管置入困难且延迟，患者病情恶化至心脏骤停，但在成功进行心肺复苏和插入鼻胃管后，患者病情稳定。进行了剖腹手术并对破裂的膈肌进行了一期修复。患者恢复顺利。
在张力性气胸的鉴别诊断中应考虑急性张力性内脏胸腔疝，其初始复苏应包括插入鼻胃管立即减压。
