BMJ Case Reports 2017; doi:10.1136/bcr-2016-218571
  • Unusual association of diseases/symptoms

Tension enterothorax and hepatothorax due to a diaphragmatic hernia: successful emergency repair of a life-threatening condition

  1. Piers Gatenby2
  1. 1General Surgery, Western Sussex Hospitals NHS Trust, Worthing, UK
  2. 2Oesophagogastric Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
  1. Correspondence to Dr Eirini Martinou, martinoueirini{at}
  • Accepted 17 May 2017
  • Published 14 June 2017


A 70-year-old female patient presented with acute severe respiratory distress at a district general hospital. Medical history included type 2 diabetes, recurrent pulmonary embolisms and pre-existing diaphragmatic hernia containing part of the liver. Despite initial treatment with steroid inhalers, her clinical picture rapidly deteriorated requiring emergency intubation and positive pressure ventilation. Imaging investigations revealed tension enterothorax and hepatothorax with tracheal deviation. The patient was transferred and underwent an emergency laparotomy at the Regional Oesophagogastric Unit. A large diaphragmatic hernia (central tendon defect) which contained the duodenum, porta hepatis, right lobe of liver, gallbladder and right colon was reduced and successfully repaired. Her postoperative course was uneventful with no signs of recurrence at 2 months follow-up.

This case describes an extremely rare and life-threatening condition of tension enterothorax and hepatothorax, which should be considered in the differential diagnosis of acute respiratory distress with tracheal deviation.


  • Contributors EM and PG have contributed to this article. EM: writing of article. PG: primary surgeon and editor of article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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