Internal herniation of the anterior gastric wall through an attenuated Nissen Fundoplication wrap: an unusual complication and its laparoscopic management

Abstract

Laparoscopic Nissen fundoplication is the treatment of choice for medically refractive gastro-oesophageal reflux disease as it is considered safe, cost efficient and effective. Unusual variants of internal abdominal herniation, however, have been reported after the procedure. Here, we present a case of a 38-year-old woman who presented 3 months after a successful laparoscopic Nissen Rossetti fundoplication, with abdominal pain and persistent vomiting. Abdominal X-ray at the time of admission was normal but CT suggested internal herniation of the stomach. Laparoscopy confirmed internal herniation of the anterior wall of the stomach through an attenuated fundoplication wrap. We show that a prompt diagnosis of this complication, which we have not found reported previously in the English literature, can be achieved by CT, permitting an early laparoscopic intervention to preserve the viability of the obstructed segment of stomach.