scholarly journals Thoracic stomach syndrome after whole-stomach esophagectomy for esophageal cancer mimicking tension pneumothorax: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Daisuke Hasegawa ◽  
Hidefumi Komura ◽  
Ken Katsuta ◽  
Takahiro Kawaji ◽  
Osamu Nishida
Keyword(s):  
Esophageal Cancer ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Nasogastric Tube ◽  
Tension Pneumothorax ◽  
Differential Diagnoses ◽  
Tube Placement ◽  
Asian Woman ◽  
Thoracic Cavity ◽  
Thoracic Stomach

Abstract Background Sudden 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 presentation A 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. Conclusions Similar 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.

Palliative nasogastric tube placement for patients with advanced esophageal cancer with nearly total obstruction: Consider the feasibility and acceptability considerations

2019 ◽  
Author(s):  
CHIH WEI YANG ◽  
I-Hsuan Huang ◽  
Wei-Kuo Chang
Keyword(s):  
Esophageal Cancer ◽  
Hospital Stay ◽  
Survival Time ◽  
Nasogastric Tube ◽  
Tertiary Care ◽  
Caloric Intake ◽  
Length Of Hospital Stay ◽  
Tube Placement ◽  
Advanced Esophageal Cancer ◽  
Observation Study

Abstract Background: Nasogastric tube (NGT) feeding was reasonable choice for patients with advanced esophageal cancer with a short-life expectancy. Bedside blind NGT placement beyond the nearly total obstruction lesion usually fail and is challenging. Each individual patient might have different cancer stage, tumor location and size, natural course of the disease, technique feasibility, and tolerability of NGT placement. This study evaluates the benefits and limitations of palliative NGT placements for advanced esophageal cancer during their last months of life. Method: Retrospective observation study was performed. We implemented three techniques of palliative NGT placement, compared the advantages and limitations, and evaluated the clinical outcomes in patients advanced esophageal cancer with nearly total obstruction. The present study was performed in at a tertiary care teaching hospital, Taiwan. Patients (n =32) received palliative care, failure of bedside blind NGT placement, and/or NPO (Nil per os) treatment were included. Patients were divided into different palliative NGT placements: guidewire method (n = 6), the drag method (n = 6), push method (n = 10). Results: Success rate of palliative NGT placement was observed in the guidewire method (75%), drag method, (100%), and push method (93%). Compared the palliative NGT groups to NPO group, NGT groups had significantly increased in enteral caloric intake (p < 0.05), serum albumin level (p < 0.01), decreased the length of hospital stay (p = 0.01), but increased the survival time (p = 0.01). Conclusion: Patients who tolerated the NGT placement will able to receive desired caloric intake, decrease length of hospital stay, and increase the overall survival time.

scholarly journals Traumatic occurrence of chest wall tamponade secondary to subcutaneous emphysema

CJEM ◽  
2008 ◽  
Vol 10 (04) ◽  
pp. 387-391 ◽  
Author(s):  
Michael Perraut ◽  
Daniel Gilday ◽  
Gordon Reed
Keyword(s):  
Respiratory Failure ◽  
Subcutaneous Emphysema ◽  
Unusual Case ◽  
Positive Pressure Ventilation ◽  
Tension Pneumothorax ◽  
Tube Placement ◽  
Positive Pressure ◽  
Management Options ◽  
Physical Finding ◽  
Life Threatening

ABSTRACTSubcutaneous emphysema is a physical finding that itself is usually perceived as benign yet rarely may, in and of itself, be life-threatening. We present an unusual case of a 67-year-old woman who developed delayed severe subcutaneous emphysema and tension pneumothorax from a rib fracture subsequent to a fall. We review the pathophysiology, manifestations and management options of this disorder. In patients whose clinical condition allows it, chest tube placement prior to intubation should be considered. Furthermore, positive end-expiratory pressure should be minimized. We present a case that illustrates how subcutaneous emphysema itself can be a potential cause of respiratory failure and tamponade physiology. In our case, a patient with traumatic subcutaneous emphysema developed respiratory failure and clinical deterioration after the introduction of positive pressure ventilation. In such rare scenarios, care should be taken to consider the absolute need for positive pressure ventilation without surgical decompression.

scholarly journals Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Narjis AL Saif ◽  
Adel Hammodi ◽  
M. Ali Al-Azem ◽  
Rasheed Al-Hubail
Keyword(s):  
Critically Ill ◽  
Nasogastric Tube ◽  
Tension Pneumothorax ◽  
Tube Placement ◽  
Insertion Technique ◽  
Tube Insertion ◽  
Surgical Emphysema ◽  
Nasogastric Tube Placement ◽  
Nasogastric Tube Insertion ◽  
Fatal Complications

Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

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