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The authors report on a 13- year- old boy who, after exercise, had respirat ory distress and left upper quadrant abdominal pain. Initially, a mistaken diagn osis of pneumothorax was made, and a chest tube was inserted. A nasogastric tube was then visualized on chest x- ray in the left hemithorax. He underwent a lap arotomy and had herniation of spleen, stomach, and large and small bowel in the left pleural space passing through a traumatic defect in the hemidiaphragm. The laparoscopic Nissen fundoplication 3 years prior was felt to have contributed. A timely and correct diagnosis is essential to avoid the sequelae associated with these injuries and with inappropriate tube thoracostomy.
The authors report on a 13- year- old boy who, after exercise, had respirat ory distress and left upper quadrant abdominal pain. Initially, a mistaken diagnosis of pneumothorax was made, and a chest tube was inserted. A nasogastric tube was then visualized on chest x-ray in the left hemithorax. He underwent a lap arotomy and had herniation of spleen, stomach, and large and small bowel in the left pleural space passing through a traumatic defect in the hemidiaphragm. The laparoscopic Nissen fundoplication 3 years prior A timely and correct diagnosis is essential to avoid the sequelae associated with these injuries and with inappropriate tube thoracostomy.