TENSION GASTROTHORAX: OCCULT CHILDHOOD DIAPHRAGMATIC INJURY PRESENTING AS ACUTE EMERGENCY IN PREGNANCY.

We present a case of tension gastrothorax in a 27 year old primigravida with the complaints of respiratory distress. She was hypoxic and tachycardiac. Left thorax was resonant to percussion and had no air entry. Chest X ray was not helpful to reach the diagnosis. Later on tracheal deviation was noted and thoracostomy was done. The patient aborted overnight. Greenish fluid in the chest drain led to investigation with computed tomography which revealed massive vicerothorax. Review of her history revealed that she had blunt abdominal injury as child. Laparotomy confirmed the above findings along with a gastric perforation. Diaphragm and stomach were repaired, gastropexy and caecopexy was done. Occult diaphragmatic injury can complicate the pregnancy. High intra-abdominal pressure during the pregnancy can push much of abdominal contents through the diaphragmatic defect. Creation of angulation at gastro esophageal junction acts as a one way valve and thus leads to progressive dilation of the stomach, resulting in tension gastrothorax. [ABSTRACT FROM AUTHOR]