Main Article Content
Abstract
Background: Gastric volvulus, an abnormal rotation of the stomach, is a rare surgical emergency that can lead to life-threatening gastric ischemia and perforation, particularly when associated with a large paraesophageal hernia (PEH). While paraesophageal hernias are the most common predisposing factor in adults, the optimal surgical management, especially regarding the use of fundoplication and gastropexy, remains a subject of debate.
Case presentation: We present the case of a 46-year-old male with a six-month history of intermittent epigastric pain and early satiety, who presented with a three-week history of acute-on-chronic gastric outlet obstruction. His symptoms included intractable postprandial vomiting. Laboratory findings were significant for hemoconcentration and a hypochloremic, hypokalemic metabolic state, indicative of severe dehydration. A contrast-enhanced computed tomography scan confirmed a Type II PEH with an organoaxial gastric volvulus, causing complete obstruction. Following aggressive resuscitation, the patient underwent successful laparoscopic surgery. The procedure involved reduction of the herniated and volvulized stomach, complete excision of the hernia sac, and a primary posterior crural repair with pledgeted, non-absorbable sutures. A fundoplication or gastropexy was not performed. Intraoperative endoscopy confirmed successful de-rotation, a patent pylorus, and viable gastric mucosa. The patient had an uneventful recovery and remained asymptomatic with no evidence of reflux at a six-month follow-up.
Conclusion: This case highlights the classic "acute-on-chronic" presentation of gastric volvulus secondary to a PEH. It underscores the efficacy and safety of a laparoscopic approach, which facilitates rapid recovery. Furthermore, it suggests that in carefully selected cases with a moderate-sized hiatal defect and preserved anatomy post-reduction, a meticulous primary crural repair without routine fundoplication or gastropexy can be a sufficient and durable treatment, avoiding the potential morbidity of these additional procedures.
Keywords
Article Details
As our aim is to disseminate original research article, hence the publishing right is a necessary one. The publishing right is needed in order to reach the agreement between the author and publisher. As the journal is fully open access, the authors will sign an exclusive license agreement.
The authors have the right to:
- Share their article in the same ways permitted to third parties under the relevant user license.
- Retain copyright, patent, trademark and other intellectual property rights including research data.
- Proper attribution and credit for the published work.
For the open access article, the publisher is granted to the following right.
- The non-exclusive right to publish the article and grant right to others.
- For the published article, the publisher applied for the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.