Asian Cardiovasc Thorac Ann 2003;11:375
© 2003 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Tension Enterothorax
Wong Poo-Sing, FRCS (CTh),
Simon J Vendargon, MS
Department of Cardiothoracic Surgery, Sultanah Aminah Hospital, 80100 Johor Bahru, Malaysia
For reprint information contact: Wong Poo-Sing, FRCS (CTh) Tel: 65 6772 2060 Fax: 65 6776 6475 email: surwps{at}nus.edu.sg Department of Surgery, National University Singapore, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore.
A 30-year old man presented with vomiting. Chest X-ray showed air fluid levels in the left lower chest (Figure 1A
). He rapidly developed features of small bowel obstruction with cardio-respiratory distress. Chest X-ray showed dilated loops of small bowel in the left chest with contralateral mediastinal shift (Figure 1B) - left "tension enterothorax". He underwent laparotomy where a left postero-lateral diaphragmatic defect (Figure 2A) (Bochdalek defect) was identified. The spleen and ischemic small bowel (Figure 2B) were reduced into the abdomen and the defect was repaired primarily.
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Figure 1. (A) Chest X-ray on admission showing multiple air-fluid levels in the left chest; (B) Chest X-ray showing dilated loops of small bowel in the left chest with contralateral shift of mediastinum.
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Figure 2. (A) At laparotomy, a left postero-lateral diaphragmatic defect (Bochdalek defect) was identified with ischemic small bowel (arrow). (B) Ischemic small bowel removed from left hemithorax.
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