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

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.

Novel Risk Score for Fetuses with Congenital Diaphragmatic Hernia Based on Ultrasound Findings

Introduction We aimed to establish and validate a risk score for fetuses with congenital diaphragmatic hernia (CDH) using only prenatal ultrasound findings. Material and Methods Derivation (2011–2016, n = 350) and validation (2006–2010, n = 270) cohorts were obtained from a Japanese CDH study group database. Using a logistic regression analysis, we created a prediction model and weighted scoring system from the derivation dataset and calculated the odds ratio of an unsatisfactory prognosis (death within 90 days of life or hospitalization duration exceeding 180 days). Five adverse prognostic factors obtained using prenatal ultrasound, including an observed/expected lung area-to-head circumference ratio (o/eLHR) <25%, liver herniation occupying more than one-third of the thoracic space, thoracic stomach, right-side CDH, and severe malformations, were used as predictors. The obtained model was validated using the validation cohort. Results The unsatisfactory prognosis prediction model was obtained based on the adjusted odds ratios. The C statistics of the model were 0.83 and 0.80 in the derivation and validation datasets, respectively. The five variables were weighted proportionally to their adjusted odds ratios for an unsatisfactory prognosis (o/eLHR <25%, 1 point; liver herniation occupying more than one-third of the thoracic space, 1 point; thoracic stomach, 1 point; right-side CDH, 2 points; and severe malformations, 3 points). Unsatisfactory prognosis rates for the low- (0–2 points), intermediate- (3–5 points), and high-risk (6–8 points) groups were 17, 46, and 100%, respectively (p < 0.001), in the validation cohort. Conclusion Our simple risk score effectively predicted the prognosis of fetuses with CDH.

Human foetal stomach : a morphological study

Background and aims : The morphology of human stomach is subjected to wide variations and changes during developmental stage. Congenital anomalies of stomach like hypertrophic pyloric stenosis and thoracic stomach are common in new barns. Some rare anomalies like duplication, diverticula and hypoplasia of stomach also may occur. The present study attempts to analyze the morphological changes like change in shape, height, width, length of greater and lesser curvatures, capacity and localization of stomach in the quadrants of abdomen in different age groups of human foetuses and also to look for congenital anomalies. Materials and methods: Fifty normal fresh still born foetuses of age varying from 15 to 40 weeks were dissected and morphological study was carried out. Parameters like height, width, length of greater and lesser curvature,capacity of stomach were measured and location, shape, internal appearance of stomach were noted. Results: Significant changes in shape and in location of stomach in different quadrants of the abdomen were found in different foetal age groups. Localization of stomach is seen as that in adults by 25th week of foetal age. Typical 'J' shaped stomach is seen by 28th week of foetal age. Height, width, length of greater and lesser curvatures and capacity of stomach increased with increasing foetal age. A sudden increase in width was seen at 17th week and a sudden increase in height was noted at 25th week. Well developed rugae and gastric canal were seen in inner surface of stomach by 28th week. Capacity of stomach increased from 1 ml at 15th week tom 32 ml at 40th week. Conclusion: The obsevations of the present study show that morphology and location of the stomach in different age groups show great variations. This study may help in study of development of stomach and in diagnosis of different developmental anomalies, ailments and pathology of stomach.