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Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report.

Siow SL, Tee SC, Wong CM - J Med Case Rep (2015)

Bottom Line: A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen.A Toupet fundoplication was performed to recreate the antireflux valve.She had an uneventful recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia. szeli18@yahoo.com.

ABSTRACT

Introduction: Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia.

Case presentation: A 55-year-old Chinese woman presented to us with symptoms suggestive of gastric outlet obstruction for one year. A chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, where a diaphragmatic hernia was initially suspected. A computed tomography scan and barium swallow study demonstrated the presence of a type III paraesophageal hernia with intrathoracic upside-down stomach. A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen. The mediastinal part of the hernial sac was excised. Adequate intraabdominal length of oesophagus was achieved after resection of the sac and circumferential oesophageal dissection. A lateral releasing incision was made adjacent to the right crus to facilitate crural closure. The diaphragmatic defect and the hiatal closure were covered with a composite mesh. A Toupet fundoplication was performed to recreate the antireflux valve. She had an uneventful recovery. She had no relapse of previous symptoms at her six-month follow-up assessment.

Conclusions: Laparoscopic repair of such a condition can be accomplished successfully and safely when it is performed with meticulous attention to the details of the surgical technique.

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Related in: MedlinePlus

Barium swallow study showing the upside-down appearance of the stomach in the thorax with the subdiaphragmatic location of the gastroesophageal junction before surgery (a) and normal subdiaphragmatic position of the stomach one month after the surgery (b).
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Fig1: Barium swallow study showing the upside-down appearance of the stomach in the thorax with the subdiaphragmatic location of the gastroesophageal junction before surgery (a) and normal subdiaphragmatic position of the stomach one month after the surgery (b).

Mentions: A 55-year-old Chinese woman presented with a history of left hypochondrial pain for a duration of one year, associated with early satiety and postprandial vomiting. She did not report any reflux symptoms. Her physical examination did not reveal any significant abnormality. An upper endoscopy did not show any evidence of reflux oesophagitis, except for a severely deformed stomach with difficult duodenal intubation. However, a chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, and a diaphragmatic hernia was initially suspected. A computed tomography (CT) scan of her abdomen and a barium swallow study (FigureĀ 1a) confirmed a diagnosis of PEH with intrathoracic mesentericoaxial gastric volvulus.Figure 1


Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report.

Siow SL, Tee SC, Wong CM - J Med Case Rep (2015)

Barium swallow study showing the upside-down appearance of the stomach in the thorax with the subdiaphragmatic location of the gastroesophageal junction before surgery (a) and normal subdiaphragmatic position of the stomach one month after the surgery (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4355978&req=5

Fig1: Barium swallow study showing the upside-down appearance of the stomach in the thorax with the subdiaphragmatic location of the gastroesophageal junction before surgery (a) and normal subdiaphragmatic position of the stomach one month after the surgery (b).
Mentions: A 55-year-old Chinese woman presented with a history of left hypochondrial pain for a duration of one year, associated with early satiety and postprandial vomiting. She did not report any reflux symptoms. Her physical examination did not reveal any significant abnormality. An upper endoscopy did not show any evidence of reflux oesophagitis, except for a severely deformed stomach with difficult duodenal intubation. However, a chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, and a diaphragmatic hernia was initially suspected. A computed tomography (CT) scan of her abdomen and a barium swallow study (FigureĀ 1a) confirmed a diagnosis of PEH with intrathoracic mesentericoaxial gastric volvulus.Figure 1

Bottom Line: A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen.A Toupet fundoplication was performed to recreate the antireflux valve.She had an uneventful recovery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Jalan Hospital, 93586, Kuching, Sarawak, Malaysia. szeli18@yahoo.com.

ABSTRACT

Introduction: Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia.

Case presentation: A 55-year-old Chinese woman presented to us with symptoms suggestive of gastric outlet obstruction for one year. A chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, where a diaphragmatic hernia was initially suspected. A computed tomography scan and barium swallow study demonstrated the presence of a type III paraesophageal hernia with intrathoracic upside-down stomach. A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen. The mediastinal part of the hernial sac was excised. Adequate intraabdominal length of oesophagus was achieved after resection of the sac and circumferential oesophageal dissection. A lateral releasing incision was made adjacent to the right crus to facilitate crural closure. The diaphragmatic defect and the hiatal closure were covered with a composite mesh. A Toupet fundoplication was performed to recreate the antireflux valve. She had an uneventful recovery. She had no relapse of previous symptoms at her six-month follow-up assessment.

Conclusions: Laparoscopic repair of such a condition can be accomplished successfully and safely when it is performed with meticulous attention to the details of the surgical technique.

Show MeSH
Related in: MedlinePlus