Tension gastrothorax due to a Bochdalek hernia with gastric volvulus in an adult

A 25-year-old female presented to the emergency room with dyspnea, abdominal pain, and constipation for five days.On examination, the patient was noted to have a pulse rate of 104 beats and was tachypneic.Oxygen saturation was 93% on room air, while blood pressure remained within normal limits.Examination revealed absent breath sounds over the left side and a soft, non-tender abdomen.A chest radiograph showed a significant right mediastinal shift with an air-fluid level in the left hemithorax, causing left lung collapse [Figure 1a].Cross-sectional imaging identified a 6 8 cm defect in the left hemidiaphragm, causing herniation of the stomach with significant organoaxial rotation and complete spleen [Figure 1b and1c].The patient underwent emergency laparoscopic surgery, converted to laparotomy, involving partial gastric sleeve resection (gangrenous fundus), diaphragmatic hernia tissue repair, and gastropexy.A chest x-ray on postoperative day 1 demonstrated left lung re-expansion, a midline trachea, and an intercostal drain in situ [Figure 1d].The patient had an uneventful postoperative period and was subsequently discharged after 5 days.Unfortunately, the laparoscopic operative video and image recordings were corrupted and could not be submitted.