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

JOURNAL TITLE: Journal of Postgraduate Medicine, Education and Research

Author
1. Brij Sharma
2. Vishal Bodh
3. Ashish Chauhan
4. Neeti Aggarwal
5. Rajesh Sharma
6. Ashok Kaundal
ISSN
2277-8969
DOI
10.5005/jp-journals-10028-1577
Volume
56
Issue
3
Publishing Year
2022
Pages
3
Author Affiliations
    1. Jaipur Dental College, Jaipur, Rajasthan, India
    2. Fortis Escorts Heart Institute & Research Centre, New Delhi, India
    1. Department of Gastroenterology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
    2. Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
    1. Department of Gastroenterology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
    1. Department of Gastroenterology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
    1. Department of Radiology, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
    1. Department of Surgery, Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
  • Article keywords
    Bochardt\'s triad, Gastric volvulus, Hiatal hernia, Organoaxial volvulus, Paraesophageal hernia

    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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