Abstract
BackgroundSudden onset of respiratory failure is one of the most fearful manifestations in intensive care units. Among the differential diagnoses of respiratory failure, tension pneumothorax is a life-threatening disease that requires immediate invasive intervention to drain the air from the thoracic cavity. However, other etiologies with manifestations similar to those of tension pneumothorax should also be considered after whole-stomach esophagectomy for esophageal cancer. We report a rare case of a patient with thoracic stomach syndrome mimicking tension pneumothorax after esophagectomy with whole-stomach reconstruction.Case presentationA 49-year-old Asian woman was admitted to our intensive care unit after esophagectomy for esophageal cancer with whole-stomach reconstruction while under sedation and intubated. Despite initial stable vital signs, the patient rapidly developed tachypnea, low blood pressure, and low oxygen saturation. Chest radiography revealed a mediastinal shift and led to a presumptive diagnosis of tension pneumothorax. Hence, an aspiration catheter was inserted into the right pleural space. However, her clinical symptoms did not improve. Chest computed tomography was performed, which revealed a significantly distended reconstructed stomach that was compressing the nearby lung parenchyma. Her respiration improved immediately after nasogastric tube placement. After the procedure, we successfully extubated the patient.ConclusionsSimilar to tension pneumothorax, thoracic stomach syndrome requires immediate drainage of air from the thoracic cavity. However, unlike tension pneumothorax, this condition requires nasogastric tube insertion, which is the only way to safely remove the accumulated air and avoid possible complications that could occur due to percutaneous drainage. For patient safety, it might be clinically important to place nasogastric tubes after esophagectomy with whole-stomach reconstruction, even if radiographic guidance is required. In addition, clinicians should consider thoracic stomach syndrome as one of the differential diagnoses of respiratory failure after whole-stomach esophagectomy.
Highlights
Sudden onset of respiratory failure is one of the most fearful manifestations in intensive care units
Thoracic stomach syndrome (TSS) is a complication that can occur after esophagectomy for esophageal cancer with whole-stomach reconstruction [1], the main symptom of which is chest discomfort after eating [2]
We describe a case of a patient with TSS in whom TSS caused respiratory failure at the time of weaning from mechanical ventilation after esophagectomy for esophageal cancer with wholestomach reconstruction
Summary
Physicians should be aware that TSS may be a complication after esophagectomy with whole-stomach reconstruction and that its primary presentation can be respiratory failure. Performing prophylactic nasogastric tube placement to avoid TSS is important to ensure patient safety and improve overall outcomes, especially for patients on mechanical ventilation. Abbreviations FiO2: Fraction of inspired oxygen; ICU: Intensive care unit; P/F: Ratio of oxygen pressure to fraction of inspired oxygen; TSS: Thoracic stomach syndrome
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
