Gastric Volvulus as a Complication of Giant Hiatal Hernia: A Case Report and Literature Review.

Abstract

Gastric volvulus is a rare but potentially life-threatening condition that can arise as a complication of a giant hiatal hernia. It results from an abnormal rotation of the stomach, which can lead to obstruction, ischemia, or even gastric necrosis. Prompt recognition and surgical intervention are essential to prevent serious outcomes. We present the case of a 58-year-old female patient with a history of hypertension who arrived at the emergency department with acute-onset severe epigastric pain (10/10 on the Visual Analog Scale), accompanied by nausea but no vomiting. Physical examination revealed involuntary guarding in the epigastric region. Initial imaging with contrast-enhanced esophagogram showed a giant hiatal hernia with intrathoracic migration of the stomach and signs of gastric volvulus. A subsequent computed tomography (CT) scan confirmed the herniation of the gastric antrum through the esophageal hiatus with organoaxial rotation. The patient underwent urgent laparoscopic surgery. Intraoperatively, the stomach was found to be viable, with no evidence of necrosis or perforation. The herniated stomach was reduced, and the esophageal hiatus was dissected and repaired using a prosthetic mesh. The patient had an uneventful postoperative course and was discharged on the second postoperative day. She remains asymptomatic at follow-up. This case highlights the importance of early diagnosis and intervention in patients with acute gastric volvulus, especially when associated with a giant hiatal hernia. Laparoscopic repair remains the gold standard, offering reduced morbidity, faster recovery, and favorable long-term outcomes. A literature review confirms that surgical correction of the anatomical defect is essential to prevent recurrence and severe complications such as ischemia or gastric necrosis. Endoscopic and percutaneous decompression may serve as temporary measures but are not substitutes for definitive surgical treatment.