Intrathoracic Gastric Volvulus Following Laparoscopic Fundoplication: A Case Report and Review of the Literature.

Abstract

Gastric volvulus is a fatal complication that rarely occurs after Nissen fundoplication with organoaxial volvulus being the most common type. We present a case of a 36-year-old male with a surgical history of Nissen fundoplication with hiatal repair three years prior to presentation. He presented with shortness of breath, abdominal pain, and obstipation. CT scan showed no passage of the oral contrast towards the stomach. The stomach is seen completely herniated into the chest suggesting rotation along its long axis worrisome for organoaxial volvulus. Intraoperative findings were a strangulated stomach through the diaphragmatic defect and migration of the entire stomach into the chest, at which division of the diaphragm and retrieval of the stomach after extensive adhesiolysis were successfully performed. The stomach was reduced back to the abdomen but was completely black and gangrenous; thus, total gastrectomy and Roux-en-Y gastric bypass were done, and the hiatus hernia was repaired with chest tube placement. Acute gastric volvulus after laparoscopic fundoplication is a surgical emergency that presents diagnostic challenges. It should be considered in the differential diagnosis of patients experiencing recurrent vomiting following fundoplication.