Chest Pain due to Bowel Adhesion accompanying Diaphragmatic Eventration

An eighty-five-year-old female lost consciousness after drinking hot water, following coughing. As she was found to be in a deep coma with bradypnea, she was transported to our Level 1 emergency and critical care center. She had hypertension, diabetes mellitus, dementia, cataracts, had undergone gastrectomy for gastric ulcers, cholecystectomy for cholelithiasis and had required admission for postoperative adhesive intestinal obstruction three times. Upon arrival 30 minutes from the initial call, her consciousness had improved. She complained of left chest pain and her left respiratory sounds revealed stridor and peristalsis. Her arterial blood gas under the inhalation of oxygen at 4 liters per minute revealed a pH of 7.210, PCO2 of 65 mmHg, PO2 of 102 mmHg, HCO3 of 25mmol/l and a lactate level of 3.8mmol/l. An electrocardiogram was negative for abnormalities. A chest roentgenogram revealed left diaphragmatic eventration with distension of colon gas. A computed tomography scan was negative for abnormalities, and a rupture of the diaphragm was ruled out. She received a diagnosis of carbon dioxide narcosis due to aspiration and chest pain due to bowel adhesion accompanying diaphragmatic eventration. She was treated in the intensive care unitwith biphasic positive airway pressure, oxygen and antibiotics, which resulted in improvement of her respiratory function and consciousness. In cases with diaphragmatic eventration, the differential diagnosis of chest pain requires a thorough examination for intra-abdominal pathogenic disease.