Chest
Volume 104, Issue 1, July 1993, Pages 317-318
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Selected Reports
Acute Gastric Dilatation Causing Respiratory Failure and “Tension Pneumothorax” in an Elderly Woman With a Diaphragmatic Hernia

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The occurrence of respiratory failure as a result of a large diaphragmatic hernia is a well-described entity in infants with congenital hernias. On reviewing the literature, the authors did not find a smiliar clinical presentation in the adult population. They report the case of an elderly patient with a large hiatus hernia who developed recurrent episodes of life-threatening respiratory failure and hemodynamic compromise due to recurrent gastric dilatation. Decompression with nasogastric suction resulted in dramatic and immediate relief of the respiratory distress. One should keep in mind the possibility of intrathoracic gastric dilatation as a cause of acute respiratory insufficiency in patients with hiatal hernia.

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Case Report

An 84-year-old woman, a nonsmoker, was admitted to the intensive care unit of the Hadassah University Hospital because of acute respiratory failure. She had a large diaphragmatic hernia, which had been diagnosed 20 years previously on a routine chest x-ray film. Five years ago, she was hospitalized with unexplained respiratory failure that required mechanical ventilation. Two days prior to her present admission, she developed a mild nonproductive cough with progressive dyspnea but no fever. She

Discussion

In neonates, a large diaphragmatic hernia frequently results in respiratory failure. The most common form giving rise to this complication is the Bochdalek type (posterior), 4 but Morgagnis hernias5 and congenital eventration of the diaphragm8 may also impair respiratory function. Respiratory compromise is primarily due to hypoplasia of the lung tissue due to prolonged pressure in utero from the intrathoracic intestinal contents. In these patients, anatomic correction of the hernia does not

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