Abstract Introduction Tension viscerothorax (TVT) is an uncommon but life-threatening complication of diaphragmatic rupture in which herniated abdominal organs become intrathoracic and distended, producing mediastinal shift and obstructive shock. Because its clinical and radiographic features may mimic tension pneumothorax, delayed recognition can result in failed resuscitation or iatrogenic visceral injury. We present a case of traumatic TVT in which cardiac arrest was reversed after emergent thoracic decompression. Case Description A 43-year-old male sustained high-energy blunt trauma in a motorcycle collision. He was intubated in the field and underwent left needle decompression for presumed tension pneumothorax. On arrival, he remained profoundly hypotensive and hypoxemic despite bilateral chest tubes, blood product resuscitation, and airway optimization. Chest radiograph demonstrated intrathoracic colon and a nasogastric tube coiled within the left hemithorax, suggestive of diaphragmatic rupture. Before laparotomy could begin, the patient developed pulseless electrical activity. Resuscitative left thoracotomy exposed a 15-cm diaphragmatic tear with herniation of stomach, spleen, and bowel compressing the mediastinum. Immediate decompression restored spontaneous circulation. The diaphragm was repaired, pelvic hemorrhage controlled via angioembolization, and urethral injury managed cystoscopically. His postoperative course was notable for ARDS, pneumonia, staged pelvic fixation, and tracheostomy. He was discharged home ambulatory on hospital day 31. Discussion This case emphasizes the importance of maintaining suspicion for TVT when shock persists despite chest decompression. Key diagnostic clues include intrathoracic bowel gas, a displaced gastric tube, and failure of needle thoracostomy to improve physiology. Misdiagnosis may delay definitive treatment and expose herniated viscera to chest tube injury. Early surgical decompression—via thoracotomy or laparotomy—is the only lifesaving intervention when cardiac arrest or obstructive physiology develops. Survival in this case demonstrates that aggressive resuscitation, rapid operative decision-making, and multidisciplinary coordination can yield favorable outcomes even in extremis. TVT should be recognized as a distinct and reversible cause of traumatic obstructive shock. This abstract is funded by: None
Tran et al. (Fri,) studied this question.