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Case Reports
. 2014 Mar 27;8(1):107-14.
doi: 10.1159/000361012. eCollection 2014 Jan.

Gastric Cancer Arising from an Upside-Down Stomach through a Paraesophageal Hiatal Hernia

Kenji Mimatsu  1 , Hisao Kano  1 , Takatsugu Oida  1 , Atsushi Kawasaki  1 , Nobutada Fukino  1 , Kazutoshi Kida  1 , Youichi Kuboi  1 , Sadao Amano  2
Affiliations
Case Reports

Gastric Cancer Arising from an Upside-Down Stomach through a Paraesophageal Hiatal Hernia

Kenji Mimatsu et al. Case Rep Gastroenterol. .

Abstract

We report the rare case of an elderly patient with an advanced gastric cancer arising from an upside-down stomach through a paraesophageal hiatal hernia (PEH). An 82-year-old man presented with appetite loss and anemia. Upper gastrointestinal endoscopy revealed a type 1 tumor located in the middle body of the stomach. An upper gastrointestinal series and computed tomography showed organoaxial rotation of the stomach, which was located in the mediastinum, through a PEH, indicating an upside-down stomach. The preoperative diagnosis was gastric cancer arising from an upside-down stomach through a PEH. The patient underwent total gastrectomy with lymph node dissection and closure of the hernial orifice. Although a large PEH is a chronic disorder, gastric malignancies should be considered in patients with PEH manifested as an upside-down stomach due to its anatomical characteristics, and careful preoperative diagnosis is mandatory.

Keywords: Gastric cancer; Paraesophageal hiatal hernia; Upside-down stomach.

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Figures

Fig. 1
Fig. 1
a Upper esophagogastric series. The body of the stomach was located above the fundus, situated on the cephalic side, showing organoaxial rotation, and the entire stomach was located in the mediastinum, which indicated upside-down stomach. The gastric tumor (arrows) was found in the upper body of the stomach. b Coronal computed tomography images revealed that the entire stomach (arrows) was herniated into the mediastinum through the esophageal diaphragmatic hiatus.
Fig. 2
Fig. 2
Operative findings. a The entire stomach was found to be herniated through the enormously dilated hiatus into the left thorax together with the greater omentum. b The hernial orifice was found to be approximately 5 cm in diameter after the incarcerated stomach had been reduced back into the abdomen. c The crura of the diaphragm were closed and the jejunum just under the anastomosis was sutured to the crus to permanently fix the esophagojejunal anastomosis in an abdominal position.
Fig. 3
Fig. 3
Macroscopic finding showed a type 1 large tumor at the small curvature in the middle and upper body of the stomach.
See this image and copyright information in PMC

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