There is a rule in the pit. "All penetrating trauma below the level of the nipple line, is abdominal trauma as well as thoracic."
This rule is based on two anatomical truisms. The first truth is that the diaphragm is the muscular boarder separating abdomen from chest cavity.
The second is that the diaphragm is located as high in the chest as the Xiphoid, at the 4th intercostal space.
A penetrating injury may cause breech or rupture to the diaphragm which is some circumstances, may allow for abdominal organs to herniate into the chest.
A characteristic finding of a loop of bowel in the chest, is bowel sounds heard in the chest during auscultation. This is referred to as Gastrothorax, and is a rare finding.
For patients with Gastrothorax, associated abdominal pain, epigastric pain, nausea and vomiting are all common symptoms. Naturally shortness of breath, tachypnoea, tachycardia and ventilation compromise are expected.
As bowel takes up space where lung needs to inflate; gas exchange is impaired.
Initial treatment is symptomatic ventilation management. A patient is usually intubated, and positive pressure ventilation recruits thoracic real-estate, and minimises herniation. It also allows greater oxygenation of lung on the affected side and prevents collapse.
Surgery is usually needed to repair the penetrating tissue injury, and diaphragmatic rupture.
Prognostically, there is a high mortality rate, as bowel ischaemia, lung parenchyma injuries, and haemorrhage all take their toll.
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