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Giant paraesophageal hernia-related chronic gastric volvulus case to the emergent surgery

Hüseyin Çiyiltepe, Ebubekir Gündeş, Durmuş Ali Çetin, Ulaş Aday, Emre Bozdağ, Fulya Çiyiltepe

Data publikacji online: 2017/12/14
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Gastric volvulus is a rare clinical condition defined as a rotation of all or a part of the stomach by at least 180, which causes complete or partial obstruction. According to its aetiology it is classified as primary (30%, type 1) or secondary (70%, type 2). Type 1 gastric volvulus is often seen in childhood, and there is no underlying condition such as diafragmatic or intra-abdominal abnormality. Secondary gastric volvulus is usually seen in the elderly and is nearly always associated with paraesophageal and diaphragmatic hernias, diaphragm eventrations, or intra-abdominal adhesions [1, 2].
Anatomically it is divided according to the type of rotation. The rotation is defined as organoaxial if it is along the long axis of the stomach and mesenteroaxial if it is perpendicular to long axis of the stomach. Organoaxial type is encountered more frequently and is often associated with diaphragmatic hernia [3].
Some patients with secondary type gastric volvulus have no symptoms. According to the degree of rotation and rapidity of onset some patients present with intermittent vomiting, and if complete obstruction occurs patients present with Borchardt’s triad of acute epigastric pain, severe retching without vomiting, and difficulty in nasogastric tube insertion. Acute gastric volvulus, ischaemia, and necrosis is a life-threatening condition that requires immediate diagnosis and treatment. Treating the underlying cause in chronic cases will prevent acute table [4].
In this case report we aim to present a patient with organoaxial gastric volvulus due to giant paraesophaegal hernia, who was admitted to hospital with cough and shortness of breath, and a follow-up period after laparoscopic treatment.
A 50-year-old woman was admitted to the chest diseases outpatient clinic with complaints of chronic cough and shortness of breath. The results of the chest chest X-ray revealed eventration of the left diaphragm and air presentation that was thought to belong to the stomach in the left hemithorax (Figure 1). There was no underlying diseases or history of trauma. The thoraco-abdominal computed tomography (CT) of the patient showed gastric volvulus presentation, formed secondarily to paraesopageal hernia that filled the left hemithorax almost completely, and volume loss in the right hemithorax related to the shifting of the mediastinum (Figure 2). The upper gastrointestinal contrast study also revealed that the esophagogastric junction was in...

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