Gastric necrosis following a hiatal hernia: A case report

• Published in: International journal of surgery case reports 2021, Vol.79, p.108-111
• Main Authors: Longchamp, Gregoire, Andres, Axel, Abbassi, Ziad
• Format: Report
• Language: English
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.12.092

INTRODUCTIONGastric volvulus are rare. Complications can be life threatening, including necrosis and perforation. Assessment of mucosal viability is essential, and urgent surgical intervention is mandatory in case of vascular compromise. PRESENTATION OF CASEAn 72-year-old female known for a paraesophageal hiatal hernia was admitted at our emergency department with acute abdominal pain. Blood count demonstrated leukocytosis and increased C-reactive protein. Abdominal computed tomography showed a mesenteroaxial gastric volvulus. Urgent upper endoscopy revealed mucosal ischemia, which prompted immediate laparotomy with partial gastrectomy, cruroplasty, and Dor fundoplication. Postoperative course was uneventful. DISCUSSIONGastric volvulus is initially treated with nasogastric tube decompression, but definitive treatment is achieved surgically. When there is an associated hernia, closing the anatomical defect and fundoplication should be performed. Complication such as necrosis is associated with a high mortality, and requires urgent surgical repair. CONCLUSIONGastric volvulus can be life-threatening. Urgent endoscopic or surgical assessment should be conducted to assess mucosal viability.