An Adult-onset Case of Acute Gastric Volvulus and Incarceration by the Esophageal Hiatus

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 76; no. 2; pp. 274 - 278
• Main Authors: HIRATA, Ken, KUGA, Takayuki, OKA, Kazuhito, AMASAKI, Youtaro, KUNISUE, Yuka, HAMANO, Kimikazu
• Format: Journal Article
• Language: English; Japanese
• Published: Japan Surgical Association 2015
• Subjects: adult; esophageal hiatus hernia; gastric volvulus
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.76.274

An 82-year-old woman was admitted to our hospital because of repeated nausea and vomiting for a week. An upper gastrointestinal endoscopy revealed convergence of the stomach mucosa. Additionally, a computed tomography scan showed an upside-down stomach, which is an esophageal hiatus hernia, complicated by gastric volvulus. The hernia sac contained most of the stomach, transverse colon, and omentum. Because conservative therapy using a nasogastric tube or upper gastrointestinal endoscope failed, emergency surgery was performed via laparotomy with a hypochondrial incision. The stomach was incarcerated by the esophageal hiatus, tightly restricting the body and pylorus. The incarcerated organs were reduced by making an incision in the esophageal hiatus ; however, the stomach could not be preserved because the gastric wall was severely damaged. Therefore, distal gastrectomy and Billroth I reconstruction were performed. The hernia sac was resected, and the esophageal hiatus was repaired directly with interrupted sutures. No esophageal regurgitation occurred after the operation without any additional procedures such as fixation of the gastric wall or fundoplication. Although gastric volvulus is relatively rare in adults, most cases of acute onset or incarceration require emergent surgery, occasionally with gastrectomy, as in the present case.