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

Table 1 Summary of intensive care unit clinical monitoring

Postoperative day	Events	Vital signs	Labs
0 (September 30th, 2025)	ICU admission. Placement of central venous catheter. Nil per os 2 L/minute nasal cannula	Heart rate: 105 bpm, blood pressure: 103/68 mmHg, SpO2: 90%	Morning venous blood gas pH 7.32, PCO2: 35.9 mmHg (4.8 kPa), HCO3: 18.6 mmol/L, lactate: 6.7 mmol/L, blood count, leucocytes: 17.4 × 103/μL, neutrophils: 91.1%
	Chest X-ray: Evidence of reexpansion edema in the left hemithorax, associated with apical pneumothorax	Heart rate: 102 bpm, blood pressure: 98/70 mmHg, SpO2: 93%	Afternoon venous blood gas pH 7.36, PCO2: 41.8 mmHg (5.6 kPa), HCO3: 23.9 mmol/L, lactate: 2.5 mmol/L, blood count, leucocytes: 11.5 × 103/μL, neutrophils: 86.4%
1 (October 1st, 2025)	Oxygen requirements reduced to 1 L/minute	Morning heart rate: 88 bpm, blood pressure: 107/67 mmHg, SpO2: 93%	Venous blood gas pH 7.35, PCO2: 52.8 mmHg (7.0 kPa), HCO3: 29.6 mmol/L, lactate 14 mmol/L, blood count, leucocytes: 7.9 × 103/μL, neutrophils: 76.5%, C-reactive protein: 18.28 mg/dL
		Afternoon heart rate: 82 bpm, blood pressure: 106/71 mmHg, SpO2: 94%
2 (October 2nd, 2025)	Off oxygen supplementation	Morning heart rate: 87 bpm, blood pressure: 114/74 mmHg, SpO2: 98%	Venous blood gas pH 7.35, PCO2: 52.8 mmHg (7.0 kPa), HCO3: 29.6 mmol/L, lactate: 1.4 mmol/L, blood count, leucocytes: 7.9 × 103/μL, neutrophils: 76.5%
		Afternoon heart rate: 69 bpm, blood pressure: 112/71 mmHg, SpO2: 92%
3 (October 3rd, 2025)	Second-look scheduled	Heart rate: 78 bpm, blood pressure: 127/88 mmHg, SpO2: 96%	Blood count leucocytes: 5.5 × 103/μL, neutrophils: 64.7%

During intensive care unit admission, the patient maintained stable vital signs and demonstrated a progressive decline in leukocyte count and lactate levels, correlating with hemodynamic stabilization and clinical improvement. ICU: Intensive care unit; HCO₃: Bicarbonate; PCO₂: Partial pressure of carbon dioxide; SpO₂: Peripheral capillary oxygen saturation.

Table 2 Summary of key postoperative events following the second-look laparoscopy

Postoperative day	Events
1 (October 4th, 2025)	Clear liquid diet initiated
2 (October 5th, 2025)	Due to chest X-ray findings (left pleural effusion) and SpO2 of 85%, oxygen supplementation initiated at 15 L/minute. Nasogastric tube maintained, and clear liquid diet continued
3 (October 6th, 2025)	Nasogastric tube removed
4 (October 7th, 2025)	Pureed/soft diet initiated, and Foley catheter remove
5 (October 8th, 2025)	Parenteral nutrition suspended
6 (October 9th, 2025)	Oxygen supplementation reduced to 1 L/minute, followed by its removal
7 (October 10th, 2025)	Central venous catheter removed, and patient discharged from the hospital

Postoperative day-by-day clinical events and recovery milestones following second-look laparoscopy. SpO₂: Peripheral capillary oxygen saturation.