Gastric volvulus as a rare complication of hiatal hernia: A rare case report

Gastric volvulus (GV) is an uncommon surgical emergency characterized by abnormal rotation of the stomach, often leading to obstruction and ischemia. It is commonly associated with hiatal hernias (HHs), which represents about 75 % of secondary GV cases. Early diagnosis and prompt surgical intervention are critical to prevent life-threatening complications.

A 52-year-old female with a history of symptomatic HH presented with worsening retrosternal pain, heartburn, and early satiety. Imaging studies, including CT and upper gastrointestinal endoscopy, demonstrated a large Type III HH with entire intrathoracic migration of the stomach and secondary GV. Emergency laparoscopic repair with Nissen fundoplication was performed, resulting in successful resolution of the volvulus and an uneventful postoperative recovery.

GV remains a diagnostic challenge due to its nonspecific symptoms, often overlap with both cardiac and other gastrointestinal diseases. In HH patients, GV should be suspected, particularly those with progressive symptoms. Imaging plays a crucial role in diagnosis. Minimally invasive surgical techniques, such as laparoscopic repair with fundoplication, are effective in addressing both the volvulus and underlying anatomical defects, offering reduced morbidity and faster recovery.

This case highlights the value of prompt identification and surgical correction of GV in the setting of HH. Laparoscopic surgery performed in a timely manner can prevent critical complications and significantly enhance patient results.