Management of acute upside-down stomach

BMC Surgery

Case Report

Thomas P Hüttl¹  Tobias S Schiergens²  Wolfgang E Thasler²  Michael N Thomas² 

[1] Department of Surgery, Chirurgische Klinik München-Bogenhausen, Munich, Germany;Department of Surgery, University of Munich, Campus Grosshadern, Munich, Germany;

关键词: Upside-down stomach;    Hiatal hernia;    Paraesophageal hernia;    Gastric incarceration;    Gastric outlet obstruction;    Gastric volvulus;   

DOI  :  10.1186/1471-2482-13-55

 received in 2013-03-14, accepted in 2013-11-12,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundUpside-down stomach (UDS) is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. Symptoms may vary heavily as they are related to reflux and mechanically impaired gastric emptying. UDS is associated with a risk of incarceration and volvulus development which both might be complicated by acute gastric outlet obstruction, advanced ischemia, gastric bleeding and perforation.Case presentationA 32-year-old male presented with acute intolerant epigastralgia and anterior chest pain associated with acute onset of nausea and vomiting. He reported on a previous surgical intervention due to a hiatal hernia. Chest radiography and computer tomography showed an incarcerated UDS. After immediate esophago-gastroscopy, urgent laparoscopic reduction, repair with a 360° floppy Nissen fundoplication and insertion of a gradually absorbable GORE® BIO-A®-mesh was performed.ConclusionGiven the high risk of life-threatening complications of an incarcerated UDS as ischemia, gastric perforation or severe bleeding, emergent surgery is indicated. In stable patients with acute presentation of large paraesophageal hernia or UDS exhibiting acute mechanical gastric outlet obstruction, after esophago-gastroscopy laparoscopic reduction and hernia repair followed by an anti-reflux procedure is suggested. However, in cases of unstable patients open repair is the surgical method of choice. Here, we present an exceptionally challenging case of a young patient with a giant recurrent hiatal hernia becoming clinically manifest in an incarcerated UDS.

【 授权许可】

CC BY   
© Schiergens et al.; licensee BioMed Central Ltd. 2013