Clinical Challenges in Tension Gastrothorax: A Tale of Two Cases and Review of the Literature

Tension gastrothorax is a life-threatening condition characterized by herniation of the stomach into the thoracic cavity, leading to a mediastinal shift, causing obstructive shock. It can be frequently misdiagnosed as tension pneumothorax due to similar presentations. Prompt recognition is crucial to reduce associated morbidity and mortality. We present 2 adult cases of acute hypoxemic respiratory failure that progressed to tension gastrothorax with the use of noninvasive positive-pressure ventilation. Emergent management involves decompression strategies with nasogastric tube placement, but definitive management requires surgical correction. These cases underscore the importance of early diagnosis and appropriate management to improve patient outcomes.