Acute Intrathoracic Gastric Volvulus from a Diaphragmatic Hernia after Left Splenopancreatectomy: Report of a Case

Abstract

Intrathoracic gastric volvulus is a rare event. It occurs when the stomach undergoes organoaxial torsion in the chest, caused either by concomitant enlargement of the hiatus or by a diaphragmatic hernia. A delay in diagnosis and treatment can result in fatal complications such as gastric ischemia, perforation, and hemorrhage. We report a case of intrathoracic localization of an acute and incarcerated organoaxial gastric volvulus caused by a left-sided diaphragmatic hernia resulting from a diaphragmatic injury. The patient had undergone a left splenopancreatectomy 4 years earlier for non-Hodgkin's lymphoma. We performed an emergency left thoracotomy with reduction of the acute volvulus, resection of the adhesions, and exeresis of an inflammatory mass from the omentum, with good results. The mechanisms of volvulus and diaphragmatic hernia with the relative diagnostic and therapeutic implications are discussed after this case report.

Emergency surgery due to diaphragmatic hernia: case series and review

“…Case 6 [10]: A 51-year-old man, referred to a history of 5 months of dyspnea, abdominal pain, nausea and vomiting. These symptoms had increased in severity during the previous 2 weeks.…”

“…A colopexy procedure was performedLeft hemi diaphragm.Diaphragmatic herniation of bowelTestini M Surg Today. 2006 [10]1, M, 51Left splenopancreatectomy4 years earlierChest X-ray, CT scan, MRILeft thoracotomyLeft hemi diaphragmStomachLuu TD, Ann Thorac Surg 2006 [95]1, F, 3433 weeks’ gestationChest roentgenogram, CT scan, barium study Esophagoscopythe patient went into preterm labour and had a spontaneous vaginal delivery of a healthy new-born at 34 weeks’ gestation. left thoracotomyLeft hemi diaphragmNecrotic stomachIso Y., Hernia 2006[96]1, F, 81Morgagni’s herniaChest X-rayThe diaphragm defect was sutured first, and partial resection of the transverse colonRight thoraxtransverse colonEglinton T, ANZ J Surg.…”

Delayed presentation of congenital diaphragmatic hernia manifesting as combined-type acute gastric volvulus: a case report and review of the literature

“…This entity occurs when the stomach rotates into an abnormal position within the chest through the diaphragmatic defect. Increased intraabdominal pressure can then lead to lifethreatening gastric strangulation [27][28][29]. A delay in the diagnosis and treatment may result in fatal consequences.…”

Bockdalek Hernia With Gastric Volvulus With Ischemia in An Adult: A Case Report

“…Nissen and Allison techniques) [13][14][15]. Other procedures that are less commonly associated with gastric volvulus include left nephrectomy, splenectomy, and esophogastrectomy [16].…”

“…2017;7(1-2): [15][16][17][18][19] around itself or other structures [16]. Gastric volvulus occur relatively infrequently compared to those found in other locations and their pathophysiology is also unique by comparison [16].…”