Acute Gastric Volvulus on Hiatal Hernia

Abstract

The gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, creating the conditions of an upper abdominal obstruction with gastric dilation and risk of strangulation. It is a rare entity that requires a surgical treatment, and its diagnosis is often delayed due to frequently aspecific symptoms. We will describe the observation of a 62 year old patient who presented to the emergency department for acute epigastric pain with dyspnea. The thoracoabdominal CT has demonstrated a stasis stomach on pyloric obstacle evoking a gastric torsion. An upper gastrointestinal endoscopy (EGD) and an upper gastrointestinal contrast made it possible to diagnose an acute gastric volvulus on hiatal hernia. A midline laparotomy was performed with detorsion of the stomach and repair of the hiatal hernia. The patient recovered gradually and was discharged on the sixth postoperative day. Three months after the operation, the patient remained asymptomatic.

Severe Gastric Mucosal Necrosis Due to Giant Paraesophageal Hernia

“…A surgical approach is recommended for symptomatic patients, especially those presenting with obstructive symptoms and volvulus [ 19 ]. In patients with severe gastric necrosis secondary to PEH, surgical intervention is essential to resolve symptoms and reduce the risk of incarceration or volvulus.…”

Gastric Volvulus

“…Several anatomopathological classifications have been proposed, and the most complete one was proposed by Von Haberer and Singleton, modified by Carter in 1978 describing three types of gastric volvulus according to the axis of rotation: organoaxial, mesenteroaxial and combined [1,2,5,11].…”

“…It causes the greater curvature of the stomach to rest superior to the lesser curvature, resulting in an 'inverted' stomach. The distinguishing feature of this variant is that it lies in the horizontal plane when viewed on plain radiography Figure 1 [1,2,5,11].…”

“…This type is more likely found in the pediatric population and is rarely described in adult individuals. Strangulation is less likely to occur due to spontaneous detorsions with recurrent acute episodes Figure 2 [1,2,5,11].…”

An Unusual Case of an Acute Mesenteroaxial Gastric Volvulus Secondary to a Hiatal Hernia

“…EGD can be both diagnostic and therapeutic; however, diagnosis via endoscopy may be established in only 28%-45% of cases [10]. Distortion of the gastric anatomy and difficulty in advancing the gastroscope through the stomach or pylorus are highly suggestive of gastric volvulus with GOO [10][11][12].…”