Endoscopic Reduction of a Gastric Volvulus Associated with a Paraesophageal Hernia

Abstract

Figure 1 An 83−year−old woman with a known history of hiatus hernia was admitted to our unit complaining of retrosternal discomfort and repeated vomiting. A chest radiograph on admission revealed a distended precordial gas− tric bubble, suggestive of intrathoracic gastric herniation. Initial upper endoscopy revealed bi− zarre gastric anatomy and it was not possible to negotiate the pyloric channel. Barium meal (a) and computed tomography (b) confirmed the diagnosis of paraesophageal hernia with intra− thoracic upside−down stomach. Figure 3 The lower part of the stomach was negotiated easily after the endoscopic reduc− tion, and these post−reduction views show the twisted stomach (white arrow) and the parae− sophageal hernia (black arrow) (a), and the twisted stomach (b). Elective laparoscopic hia− tal closure and gastropexy was performed 3 days later. Figure 2 Upper endoscopy was repeated and, using a J−type maneuver, the organoaxial volvu− lus was successfully derotated in an anticlock− wise direction (arrow). Images in Focus 787This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.

Acute gastric volvulus: a surgical emergency

“…If no signs of ischemia are suspected, endoscopic devolvulation can be attempted especially in patients at high surgical risk (4). In case of ischemia or failure of endoscopic detorsion, surgery still remains as the treatment of choice.…”

Successful Gastric Volvulus Reduction and Gastropexy Using a Dual Endoscope Technique

“…Presently, first line treatment of this disorder is still with open and more recently with laparoscopic surgery [1,8]. Although the exact role of endoscopy is still not entirely clear in treating volvulus, endoscopic techniques for volvulus reduction have been successfully employed in high surgical risk patients without signs of ischemia [9][10][11][12]. We report here a unique case of gastric volvulus that was endoscopically managed using a novel strategy that to our knowledge has not been previously described in the literature.…”

Acute gastric volvulus in a patient with trisomy 21

“…As a nasogastric tube or a gastroscope was unable to reach the stomach, it was opted to immediately perform an emergency operation. Due to the severe distended stomach, adequate intra-abdominal space was not available so that laparoscopic operation was no option for this patient as report in other cases [ 6 , 7 ]. Laparotomy showed a large, distended, and twisted stomach (Figure 1 c and 2 ).…”