Hiatal hernia with gastric volvulus and perforation: a rare complicated entity

Gastric volvulus with perforation is a rare and potentially catastrophic complication of hiatal hernia. Gastric volvulus complicates ~4% of hiatal hernia cases. We present a case of a 71-year-old male patient who presented with severe progressive generalized abdominal pain associated with absolute constipation, nausea, and vomiting ongoing for 8 days before admission. An abdominal computed tomography scan demonstrated a large hiatal hernia with organoaxial gastric volvulus and pneumoperitoneum around the stomach, denoting gastric volvulus with perforation. During laparotomy, the abdomen was found to be filled with turbid fluid, and the stomach herniated into the thoracic cavity, forming a gastric volvulus with signs of inflammation and a pyogenic membrane. There was a small peripyloric perforation ~5 mm. Repair of the hiatal hernia and gastric perforation was done. In this case report, we present the diagnostic approach and surgical options of a complicated hiatal hernia with gastric volvulus and perforation.