A case of acute mesentero-axial gastric volvulus in a patient with a diaphragmatic hernia: experience with a laparoscopic approach

Abstract

Gastric volvulus is an uncommon but serious surgical condition mandating an early diagnosis and surgical intervention. It may present either acutely or chronically with epigastric pain, retching and vomiting. There are two types of gastric volvulus: organo-axial and mesentero-axial. We report a case of a mesentero-axial gastric volvulus in a 49-year-old woman with a left-sided diaphragmatic hernia. She presented with a significant epigastric pain and vomiting. A flexible upper endoscopy, a barium meal and a contrast-enhanced computed tomography imaging had confirmed the diagnosis. She was treated with a laparoscopic mesh repair of the diaphragmatic defect followed by a gastropexy. She had an uneventful postoperative course and was asymptomatic thereafter.

Figure 1:

Chest x-ray showing an elevated air-fluid left in the left basal lung region.

Figure 2:

Flexible upper endoscopy showing herniation of the distal stomach, the pylorus and the first part of the duodenum into the left hemi-thorax.

Figure 3:

Different views of a double contrast-enhanced CT scan showing a left diaphragmatic hernia with an acute dilated stomach.

Figure 4:

Water-soluble gastrografin meal showing an intra-thoracic mesentero-axial volvulus.

Figure 5:

Laparoscopic view showing the incarcerated content in the peritoneal sac with a twisted stomach.

Figure 6:

Laparoscopic view showing a large (size 7 × 7 cm) diaphragmatic defect.

Figure 7:

Laparoscopic view showing the primary closure of the diaphragmatic defect using an interrupted PDS™ II Suture.

Figure 8:

Laparoscopic view showing BIO-A^® Tissue Reinforcement absorbable mesh (size 15 × 12 cm) fixed intraperitoneally below the defect.

Figure 9:

Water-soluble gastrografin meal showing normal intra-abdominal position of the stomach.

Figure 10:

Follow-up flexible upper endoscopy showing normal gastric anatomy.