Thoracic Stomach Syndrome Mimicking Tension Pneumothorax after Whole-stomach Esophagectomy for Esophageal Cancer: A Rare Case Report

Tension pneumothorax is a life-threatening disease that requires immediate invasive intervention to drain the air from the thoracic cavity and is one of the causes of onset of respiratory failure in intensive care units. However, there can be other causes of respiratory failure mimicking tension pneumothorax after whole-stomach esophagectomy for esophageal cancer. We report a rare case of a patient with thoracic stomach syndrome (TSS) resembling tension pneumothorax after esophagectomy with whole-stomach reconstruction. A 55-year-old male was admitted to the intensive care unit after esophagectomy for esophageal cancer with whole-stomach reconstruction. Suddenly, the patient developed tachypnea, low blood pressure, and low oxygen saturation and was admitted to the emergency department after the 10 th postoperative day. There was a history of overeating and aerophagy. Chest radiography revealed right tension pneumothorax with a mediastinal shift. Hence, an intercostal chest tube 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. His respiration improved immediately after nasogastric tube placement which was done under fluoroscopy control to avoid injury to the suture line of reconstruction. Similar to tension pneumothorax, TSS requires immediate drainage of air from the filled stomach. 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 TSS as one of the differential diagnoses of respiratory failure after whole-stomach esophagectomy.