Clinical Snapshot
Cardiovascular Arrest Due to Tension Enterothorax During Pregnancy
; ;
An otherwise healthy 24-year-old woman at 30 weeks and 6 days of gestation was admitted to the hospital with left abdominal pain (VAS 6). Gynecological and general medical ultrasonography yielded no evidence of an enterothorax, and she had no chest pain. The next morning, she sustained a cardiovascular arrest and was immediately resuscitated, with the aid of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). At the same time, a male infant in need of resuscitation was delivered by emergency cesarean section. The cause was left enterothorax with a tension component (Figure) due to a diaphragmatic defect. At emergency surgery, the abdominal organs were repositioned, the defect was closed, and a gastric perforation caused by ischemia was repaired. The patient was ultimately discharged from the hospital seven months later without any neurologic deficit and with a small wound that was still healing by second intention. The child sustained a hypoxic brain injury because of peripartal hypoxia. We suspect that the enterothorax was incomplete at first, with intact venous flow, and that it was only in the morning after hospital admission that the stomach became completely displaced, with kinking of the gastric outlet, interruption of venous return, and mediastinal shift.
Approximately 50 cases of incidentally detected enterothorax in pregnant women have been described in the international literature; none involved a tension enterothorax or a cardiovascular arrest.
PD Dr. med. Alexander Buia, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Asklepios Klinik Langen, a.buia@t-online.de
Dr. med. Michael Schütz, Klinik für Anästhesie und Interdisziplinäre Intensivmedizin, Asklepios Klinik Langen
Dr. med. Annette Dürr, Klinik für Gynäkologie und Geburtshilfe, Asklepios Klinik Langen
Conflict of interest statement: The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, M.D.
Cite this as: Buia A, Schütz M, Dürr A: Cardiovascular arrest due to tension enterothorax during pregnancy. Dtsch Arztebl Int 2025; 122: 419. DOI: 10.3238/arztebl.m2025.0085
