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Management of acute upside-down stomach
Tobias S Schiergens1, Michael N Thomas, Thomas P Hüttl
1Department of Surgery, University of Munich, Campus Grosshadern, Munich, Germany. Tobias.Schiergens@med.uni-muenchen.de.
BMC Surgery
|November 16, 2013
Summary
Emergent surgery is crucial for incarcerated upside-down stomach (UDS) due to life-threatening risks. Laparoscopic repair is recommended for stable patients with acute gastric outlet obstruction from UDS.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Thoracic Surgery
Background:
- Upside-down stomach (UDS) involves gastric herniation into the posterior mediastinum, causing reflux and impaired gastric emptying.
- UDS carries risks of incarceration, volvulus, gastric outlet obstruction, ischemia, bleeding, and perforation.
Observation:
- A 32-year-old male with a history of hiatal hernia presented with severe epigastric and chest pain, nausea, and vomiting.
- Imaging confirmed an incarcerated UDS, necessitating urgent intervention.
- The patient underwent esophago-gastroscopy, laparoscopic reduction, Nissen fundoplication, and mesh insertion.
Findings:
- The case highlights a challenging instance of a giant recurrent hiatal hernia presenting as an incarcerated UDS in a young patient.
- Prompt surgical intervention, including laparoscopic repair and anti-reflux procedures, is vital for managing incarcerated UDS with gastric outlet obstruction.
Implications:
- Emergent surgery is indicated for incarcerated UDS to prevent severe complications like ischemia and perforation.
- Laparoscopic reduction and repair with anti-reflux procedures are suggested for stable patients, while open repair is preferred for unstable cases.
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