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VOLUME 56 , ISSUE 3 ( July-September, 2022 ) > List of Articles

CASE REPORT

Intrathoracic Chronic Gastric Volvulus Secondary to Paraesophageal Hernia in a Young Adult: A Case Report

Rajesh Sharma, Ashish Chauhan, Brij Sharma, Vishal Bodh, Neeti Aggarwal, Ashok Kaundal

Keywords : Bochardt's triad, Gastric volvulus, Hiatal hernia, Organoaxial volvulus, Paraesophageal hernia

Citation Information : Sharma R, Chauhan A, Sharma B, Bodh V, Aggarwal N, Kaundal A. Intrathoracic Chronic Gastric Volvulus Secondary to Paraesophageal Hernia in a Young Adult: A Case Report. J Postgrad Med Edu Res 2022; 56 (3):131-133.

DOI: 10.5005/jp-journals-10028-1577

License: CC BY-NC 4.0

Published Online: 01-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: Gastric volvulus is a rare disorder seen commonly in elderly individuals with 50% of cases reported in association with hiatal hernia. Gastric volvulus commonly presents acutely as a surgical emergency, but chronic variant is also well documented. Case description: We report a case of 35-year-old gentleman, who presented with epigastric pain, postprandial fullness and weight loss of 13 kg in last 6 months. In gastroduodenoscopy, crossing gastroesophageal junction (GEJ) required maneuvering due to abnormal anatomy of stomach and on retroflexion, possible paraesophageal hernia was seen with torsion around scope. CECT abdomen was suggestive of type 3 paraesophageal hernia with gastric volvulus. Patient underwent open laparotomy with repair of hernia and devolvulization of stomach. Discussion: Gastric volvulus is characterized by abnormal rotation of the stomach around one of its axes leading to foregut obstruction with a risk of strangulation. Treatment involves devolvulization of stomach with correction of underlying pathology. Endoscopic treatment has evolved in recent years with endoscopic devolvulization and percutaneous endoscopic gastrostomy being tried as less invasive approaches, but, most of the patients require surgery either laparoscopic or open. Conclusion: High index of suspicion is needed to diagnose gastric volvulus, especially chronic variant. Any delay can lead to gastric ischemia and necrosis, and can be fatal.


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  1. Kaoukabi AE, Menfaa M, Hasbi S, et al. Acute gastric volvulus on hiatal hernia. Case Rep Surg 2020;2020:4141729. DOI: 10.1155/2020/4141729
  2. Palanivelu C, Rangarajan M, Shetty AR, et al. Laparoscopic suture gastropexy for gastric volvulus: a report of 14 cases. Surg Endosc 2007;21(6):863–866. DOI: 10.1007/s00464-006-9089-4
  3. Rashid F, Thangarajah T, Mulvey D, et al. A review article on gastric volvulus: a challenge to diagnosis and management. Int J Surg 2010;8(1):18–24. DOI: 10.1016/j.ijsu.2009.11.002
  4. Wasselle JA, Norman J. Acute gastric volvulus: pathogenesis, diagnosis, and treatment. Am J Gastroenterol 1993;88(10):1780–1784. PMID: 8213725.
  5. Lourenço S, Pereira AM, Guimarães M, et al. Gastric volvulus: a complication of hiatal hernia. Cureus 2020;12(10):e11123. DOI: 10.7759/cureus.11123
  6. Shivanand G, Seema S, Srivastava DN, et al. Gastric volvulus. Clin Imaging 2003;27(4):265–268. DOI: 10.1016/S0899-7 071(02)00549-1
  7. Grimm MO, Caris C, Witjes WPJ, et al. Reply to Emre Karabay and İlker Tınay's Letter to the Editor re: Treatment of high-grade non-muscle-invasive bladder carcinoma by standard number and dose of BCG instillations versus reduced number and standard dose of BCG instillations: results of the European Association of Urology Research Foundation Randomised Phase III Clinical Trial “NIMBUS”. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.04.066. Eur Urol 2020;78(4):e163–e164. DOI: 10.1016/j.eururo.2020.07.004
  8. Teague WJ, Ackroyd R, Watson DI, et al. Changing patterns in the management of gastric volvulus over 14 years. Br J Surg 2000;87(3):358–361. DOI: 10.1046/j.1365-2168.2000.01385.x
  9. Lee HY, Park JH, Kim SG. Chronic gastric volvulus with laparoscopic gastropexy after endoscopic reduction: a case report. J Gastric Cancer 2015;15(2):147–150. DOI: 10.5230/jgc.2015.15.2.147
  10. Ueda S, Orita H, Ito T, et al. A Case of Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy (LAPEG) for gastric volvulus. Case Rep Med 2019;2019:3468084. DOI: 10.1155/2019/3468084
  11. Bauman ZM, Evans CH. Volvulus. Surg Clin North Am 2018;98(5): 973–993. DOI: 10.1016/j.suc.2018.06.005
  12. Naim HJ, Smith R, Gorecki PJ. Emergent laparoscopic reduction of acute gastric volvulus with anterior gastropexy. Surg Laparosc Endosc Percutan Tech 2003;13(6):389–391. DOI: 10.1097/00129689-200312000-00009
  13. Katkhouda N, Mavor E, Achanta K, et al. Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery 2000;128(5):784–790. DOI: 10.1067/msy.2000.108658
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