Acute tension gastrothorax post hiatal hernia repair and Nissen fundoplication: A case report

Figure 1 Initial emergency department imaging examinations (September 29^th, 2025). A: Contrast-enhanced computed tomography of the chest, abdomen, and pelvis demonstrating tension gastrothorax caused by a left paraesophageal hernia with intrathoracic migration of the stomach and proximal duodenum; B: Chest radiograph showing a complicated hiatal hernia with rightward displacement of mediastinal structures and a concomitant left pleural effusion.

Figure 2 Intraoperative findings during initial laparoscopy. A and B: Gastric body, fundus, and greater curvature demonstrating extensive ischemic changes and a large intramural hematoma; C: Ischemic involvement of the gastroesophageal junction; D: Ischemic changes affecting the gastric body.

Figure 3 Intraoperative findings during second-look laparoscopy. A: Gastric body demonstrating restoration of normal color and perfusion; B: Gastroesophageal junction and fundus showing resolving ischemic changes with minimal residual serosal erythema.