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Acute atraumatic peri-arrest tension gastrothorax presenting to the emergency department
  1. James Phelan,
  2. Rengarajan Subramanian and
  3. Adeep Krishnan Kutty Menon
  1. Accident & Emergency, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
  1. Correspondence to Dr Rengarajan Subramanian; rengarajan.subramanian{at}


A 71-year-old woman was brought in by ambulance to the emergency department with sudden-onset difficulty in breathing whilst shopping at a large UK retail shopping centre. She had no respiratory history and portable chest X-ray revealed a huge gastrothorax, secondary pneumothorax and mediastinal shift. Clinical deterioration with haemodynamic instability required urgent decompression. Successful needle decompression followed by tube thoracostomy improved patient condition with no further complications. Surgical repair was performed but was delayed by COVID-19. This case provides a rare presentation of an acute life-threatening tension gastrothorax with difficult management considerations. A review of the management options is undertaken.

  • resuscitation
  • pneumothorax
  • gastrointestinal surgery
  • cardiothoracic surgery
  • radiology

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  • Contributors JP contributed to patient care. Initiated case review and written content of the report. Reviewed literature involved. RS contributed to review of the case and the literature. Communicated with and consented the patient. Contributed to written content of the report. AKKM contributed to patient care. Contributed to written content of the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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