The following is the summary of “Obstructive shock due to right ventricular compression by a massively expanded reconstructed gastric tube” published in the December 2022 issue of Emergency medicine by Katsuki, et al.

An inadequate output from the right ventricle (RV) is a common complication of obstructive shock, which necessitates the prompt release of the obstruction. Their emergency room received a patient who was 54 years old and was suffering from shock when he arrived. Because he had undergone an esophagectomy in the past along with gastric interposition via the retrosternal route, he was unable to consume solid foods following the procedure. After consuming a ball of rice, he fell into a critical condition and his lactate level, which is a symptom of shock, rapidly increased. 

Even though the preliminary tests were negative for any anomalies, he was admitted to the hospital for further observation. The following day, while he was lying in the supine posture 1 hour after breakfast, he once again had the same discomfort. Cardiac sonography demonstrated that the RV was significantly compressed due to a massively enlarged stomach tube, which resulted in diastolic dysfunction. After being helped into a sitting position, he eventually overcame his shock. After a closer look at the CT scans, researchers could see that the RV was being pushed down by the significantly enlarged gastric tube. 

In terms of the anatomy, the retrosternal pathway can be found in front of the RV. It is believed that the RV was externally compressed as a result of the massively dilated stomach tube, which prevented a proper amount of RV filling and resulted in the obstructive shock. In such a scenario, the patient’s position ought to be adjusted as soon as possible in order to relieve the RV compression.

Source: sciencedirect.com/science/article/abs/pii/S0735675722005897