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Long B, Easter J, Koyfman A. High risk and low incidence diseases: Pediatric digestive volvulus. Am J Emerg Med 2024; 82:153-160. [PMID: 38908340 DOI: 10.1016/j.ajem.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Pediatric digestive volvulus is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of pediatric digestive volvulus, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Pediatric digestive volvulus is a deadly condition most commonly associated with malrotation. It occurs when the stomach or small intestine twists on itself, resulting in ischemia and potentially strangulation with necrosis and perforation. Presentation differs based on the gastrointestinal (GI) segment affected, degree of twisting, and acuity of the volvulus. Gastric volvulus most commonly presents with retching with or without nonbilious emesis and epigastric distension with pain, while midgut volvulus typically presents with bilious emesis in infants. Patients with GI necrosis and perforation may present with hemodynamic compromise and peritonitis. If suspected, emergent consultation with the pediatric surgery specialist is necessary, and if this is not available, transfer to a center with a pediatric surgeon is recommended. Imaging includes plain radiography, ultrasound, or upper GI series, while treatment includes resuscitation, administration of antibiotics, and emergent surgical decompression and detorsion of the involved segments. CONCLUSION An understanding of pediatric digestive volvulus and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Joshua Easter
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
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Hare M, Salas-Parra R, Neal J, Patel V. Acute idiopathic mesenteroaxial gastric volvulus managed laparoscopically. BMJ Case Rep 2024; 17:e260253. [PMID: 38960422 DOI: 10.1136/bcr-2024-260253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Gastric volvulus is an uncommon cause of upper gastrointestinal obstruction that occurs when the stomach twists along its vertical (organoaxial) or horizontal (mesenteroaxial) axis. Its rarity combined with its non-specific presentation makes gastric volvulus a diagnostic challenge, especially when the volvulus occurs without underlying structural abnormality such as hiatal hernia. The organoaxial type comprises most cases of this rare diagnosis. Few cases of mesenteroaxial volvulus have been reported in children and even fewer in adults. Here, we present a rare case of acute, idiopathic mesenteroaxial volvulus in a patient in his 70s, that was successfully managed laparoscopically.
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Affiliation(s)
- Maia Hare
- Department of Surgery, Northwell Health, New Hyde Park, New York, USA
| | - Ruben Salas-Parra
- Department of Surgery, Northwell Health, New Hyde Park, New York, USA
| | - Jasmin Neal
- Department of Surgery, Northwell Health, New Hyde Park, New York, USA
| | - Vihas Patel
- Department of Surgery, Northwell Health, New Hyde Park, New York, USA
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Wakabayashi M, Kobori S, Aoki K, Yoshida H, Minoshima K, Kimura T, Domoto Y, Hosaka M, Ushiku H, Funatsu K, Aisaki K. Postoperative diaphragmatic hernia with upside-down stomach: a case report. J Int Med Res 2022; 50:3000605221115158. [PMID: 35915581 PMCID: PMC9350504 DOI: 10.1177/03000605221115158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 31-year-old man presented to our hospital’s Emergency Department with sudden epigastric
pain and vomiting. He had undergone endoscopic resection via the retroperitoneal route for
a retroperitoneal tumor located in the left diaphragmatic crus of the esophageal hiatus at
another hospital 8 months previously. Radiography and computed tomography showed inversion
of the stomach beyond the diaphragm into the thoracic cavity, with the gastroesophageal
junction serving as the fulcrum point. This finding led to a diagnosis of postoperative
diaphragmatic hernia accompanied by an upside-down stomach (UDS). The prolapsed stomach in
the thoracic cavity was reduced to the abdominal cavity using laparoscopic surgery. The
postoperative course was favorable, and the patient was discharged from the hospital on
postoperative day 7. No recurrence has been observed in the past 5 years. The pathological
condition of a UDS observed in esophageal hiatal hernias may be found in postoperative
diaphragmatic hernias. Laparoscopic surgery for a postoperative diaphragmatic hernia with
a UDS is considered a useful surgical procedure. Laparoscopic surgery can simultaneously
confirm the viability of the herniated organs, reduce the organs to the abdominal cavity,
and close and reinforce the diaphragm.
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Affiliation(s)
- Masakazu Wakabayashi
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Shuichi Kobori
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kana Aoki
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Hayato Yoshida
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kou Minoshima
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Tomohiro Kimura
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Yoshinori Domoto
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Miki Hosaka
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Hideki Ushiku
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kentarou Funatsu
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kazuo Aisaki
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
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Láinez Ramos-Bossini AJ, Ruiz Carazo E, Rabadán Caravaca MD. ‘Back-and-Forth Stomach’ CT Imaging Findings of a Pathophysiologic Entity Causing Acute Gastric Volvulus. Tomography 2022; 8:245-256. [PMID: 35202185 PMCID: PMC8878744 DOI: 10.3390/tomography8010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Gastric volvulus (GV) is a life-threatening emergency condition that prompts emergent surgical management. With the advent of high-resolution computed tomography (CT), the role of radiologists in its diagnosis has become essential. Although many cases of GV have been described in the literature, its pathophysiology is still poorly understood. In addition, there is substantial terminological confusion with associated entities such as paraesophageal hernia, upside-down stomach, organo-axial or chronic GV. Methods: We conducted a retrospective review of clinical, radiological findings and other relevant data for seven patients with previous radiological diagnoses of a large hiatus hernia who presented with acute GV to the emergency department of our institution. We report data on age, sex, medical history, clinical presentation, imaging, treatment and outcomes for each case. Results: The CT findings at acute presentation showed the antrum lying above the diaphragm and dilated fundus below the diaphragm. By comparing the position of the stomach at acute presentation with previous imaging examinations, we confirmed a hypothesis put forward by a few authors decades ago that re-herniation of the gastric fundus into the abdomen is a common pathophysiologic trigger leading to acute GV. This hypothesis has not been supported by modern imaging examinations. Conclusions: We have provided imaging evidence supporting that the pathophysiology of many GVs is based on caudal re-descent of hiatal hernia into the abdominal cavity. Given the terminological disparity used in the literature in this context, we believe it appropriate to introduce and extend the term ‘back-and-forth stomach’ to refer to this type of GV.
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Affiliation(s)
| | - Eduardo Ruiz Carazo
- Department of Radiology, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
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Lopes LR, Chaim FHM, Santos IGG, Coelho Neto JDS, Tercioti V, Antonio Possato Ferrer J, Andreollo NA. Video-Laparoscopic Treatment of Intrathoracic Gastric Volvulus. JSLS 2021; 24:JSLS.2020.00061. [PMID: 33447006 PMCID: PMC7791092 DOI: 10.4293/jsls.2020.00061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial. Methods Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital. Results Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m2. The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months. Conclusions Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.
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Affiliation(s)
- Luiz Roberto Lopes
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Fabio Henrique Mendonça Chaim
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Isabella Gusson Galdino Santos
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - João de Souza Coelho Neto
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Valdir Tercioti
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - José Antonio Possato Ferrer
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
| | - Nelson Adami Andreollo
- University Clinical Hospital, School of Medical Sciences, Digestive Diseases Surgical Unit and Gastrocentro, State University of Campinas, Sao Paulo, Brazil
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Gupta A, Zia B, Mullassery D, De Coppi P, Giuliani S, Curry JI, Cross KM. Congenital intrathoracic stomach can be safely managed laparoscopically. Pediatr Surg Int 2020; 36:165-169. [PMID: 31646379 DOI: 10.1007/s00383-019-04588-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Congenital intrathoracic stomach (CIS) is an uncommon pediatric surgical diagnosis where > 2/3rd of the stomach lies within the chest through a hiatus defect. We reviewed our recent experience with this condition. METHODS A retrospective single-center review of children with a diagnosis of CIS (2007-2018) was performed. Patient demographics, presentation, imaging and management were assessed. Results are expressed as median (range). RESULTS Eleven patients (6 girls) were identified with onset of symptoms at 2 (0-26) months of age. Presenting symptoms were vomiting (8/11), respiratory symptoms (4/11) and failure to thrive (2/11). Two patients had Marfan's syndrome. An upper gastrointestinal contrast study demonstrated gastric herniation in all. All were corrected laparoscopically with hiatus repair and fundoplication [age at surgery 10.5 (1.5-34.5) months]. A concurrent gastrostomy was done in children ≤ 6 months (n = 5). Enteral feeds were commenced on post-operative day one in 9 and second post-operative day in 2. At 7 (0-95) months follow-up, all were on full enteral feeds. One patient had a recurrence 6 months post-operatively, which was re-operated laparoscopically without any further recurrence. CONCLUSION This is the largest reported series of children with CIS. All could be managed laparoscopically with no conversions and a low recurrence.
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Affiliation(s)
- Alisha Gupta
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Bushra Zia
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Dhanya Mullassery
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Paolo De Coppi
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
- Stem Cells and Regenerative Medicine Section, Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Stefano Giuliani
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Joseph I Curry
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK
| | - Kate M Cross
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK.
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Felix VN, Yogi I, Senday D, Coimbra FT, Martinez Faria KV, Belo Silva MF, Previero Elias da Silva G. Post-operative giant hiatal hernia: A single center experience. Medicine (Baltimore) 2019; 98:e15834. [PMID: 31169686 PMCID: PMC6571386 DOI: 10.1097/md.0000000000015834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
To verify the results of the treatment of post-operative giant hiatal hernia (POGH).The POGH becomes each time more frequent after surgical treatment of the gastroesophageal reflux.Fifteen patients (6 females and 9 males; 43.66 ± 5.05 years old; BMI 22.13 ± 1.92) were referred to our Service, for surgical treatment of a type III POGH 30.4 ± 1.76 months after treatment of gastroesophageal reflux disease. The need for a reoperation was determined mainly by dysphagia.Reoperation was completed laparoscopically in all patients and the mean postoperative hospital stay was 3.2 ± 1.2 days (range, 1-6 days). Mortality was 0% and there were not postoperative complications. They became asymptomatic along follow-up of 2.86 ± 1.40 years. Around 1 year from the procedure, patients were submitted to control exams and barium esophagogram revealed well positioned esophago-gastric junction and signs of intact fundoplicature, the same observation having been done at esophageal endoscopy. Esophageal manometry showed preserved peristaltism, increase of resting pressure and extension of the intra-abdominal LES and significant raise of amplitude of deglutition waves at distal third of the esophagus. No reflux was observed at post-operative 24-hour pH testing.The corrective surgery of POGH can often be completed laparoscopically in experienced hands. Successful results can be obtained performing reduction of the hernia, sac excision, crural repair, anti-reflux procedure and long anterior gastropexy.
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Ramos GP, Majumder S, Ravi K, Sweetser S. Role of Diagnostic Preoperative Upper Gastrointestinal Endoscopy in Radiologically Confirmed Gastric Volvulus. Dig Dis Sci 2018; 63:3091-3096. [PMID: 30027515 DOI: 10.1007/s10620-018-5210-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/10/2018] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Gastric volvulus (GV) is a life-threatening condition that warrants prompt diagnosis and treatment. GV is a radiologic diagnosis. The role of preoperative upper gastrointestinal endoscopy (UGIE) for individuals with radiologically confirmed GV is poorly defined. Our objective was to assess the diagnostic yield of UGIE in the preoperative evaluation of patients presenting with radiologically confirmed GV. METHODS Retrospective review of all adult patients undergoing surgery for GV between July 1996 and August 2016 has been carried out. We performed analyses evaluating diagnostic yield of preoperative UGIE and compared outcomes in patients who did and did not undergo preoperative UGIE. Outcomes were diagnostic yield of preoperative UGIE, length of hospital stay, postoperative complications, and mortality at 30 days and 1 year. RESULTS In the preoperative UGIE group, the diagnostic yield was 34.6% (27/78). The most common endoscopic findings were erosive esophagitis (13/27) and clean based gastric or duodenal ulcers (5/27). There were no cases of esophago-gastric malignancy. Three patients had ulcers with stigmata of recent bleeding, and three patients had features suggestive of gastric ischemia. Endoscopic findings did not influence surgical management. There was no statistically significant difference in mortality between patients who did and did not undergo preoperative UGIE, both at 30 days (0 vs. 2.5%) and 1 year (3.8 vs. 7.5%). CONCLUSION Among patients with radiologically confirmed GV, preoperative UGIE rarely demonstrates clinically significant findings and can potentially delay definitive surgical intervention.
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Affiliation(s)
| | - Shounak Majumder
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Karthik Ravi
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Yu HX, Han CS, Xue JR, Han ZF, Xin H. Esophageal hiatal hernia: risk, diagnosis and management. Expert Rev Gastroenterol Hepatol 2018; 12:319-329. [PMID: 29451037 DOI: 10.1080/17474124.2018.1441711] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Esophageal hiatal hernia involves abnormal abdominal entry into thoracic cavity. It is classified based on orientation between esophageal junction and diaphragm. Sliding hiatal hernia (Type-I) comprises the most frequent category, emanating from right crus of diaphragm. Type-II esophageal hernia engages both left and right muscular crura. Type-III and IV additionally include the left crus. Age and increased body mass index are key risk factors, and congenital skeletal aberrations trigger pathogenesis through intestinal malrotations. Familiar manifestations include gastric reflux, nausea, bloating, chest and epigastric discomfort, pharyngeal and esophageal expulsion and dysphagia. Weight loss and colorectal bleeding are severe symptoms. Areas covered: This review summarizes updated evidence of pathophysiology, risk factors, diagnosis and management of hiatal hernias. Laparoscopy and oesophagectomy procedures have been discussed as surgical procedures. Expert commentary: Endoscopy identifies untreatable gastric reflux; radiology is better for pre-operative assessments; manometry measures esophageal peristalsis, and CT scanning detects gastric volvulus and associated organ ruptures. Gastric reflux disease is mitigated using antacids and proton pump and histamine-2-receptor blockers. Severe abdominal penetration into chest cavity demands surgical approaches. Hence, esophagectomy has chances of post-operative morbidity, while minimally invasive laparoscopy entails fewer postoperative difficulties and better visualization of hernia and related vascular damages.
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Affiliation(s)
- Hai-Xiang Yu
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Chun-Shan Han
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Jin-Ru Xue
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Zhi-Feng Han
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
| | - Hua Xin
- a Department of Thoracic Surgery , China-Japan Union Hospital of Jilin University , Changchun , China
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Laparoscopic Repair of Intrathoracic Stomach: Clinical and Health-related Quality of Life Outcomes. Surg Laparosc Endosc Percutan Tech 2016; 26:484-487. [DOI: 10.1097/sle.0000000000000349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- A Duranceau
- Department of Surgery, Division of Thoracic Surgery, Université de Montréal, Montreal, Quebec, Canada
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Koh YX, Ong LWL, Lee J, Wong ASY. Para-oesophageal and parahiatal hernias in an Asian acute care tertiary hospital: an underappreciated surgical condition. Singapore Med J 2016; 57:669-675. [PMID: 26778633 DOI: 10.11622/smedj.2016018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The prevalence of hiatal hernias and para-oesophageal hernias (PEHs) is lower in Asian populations than in Western populations. Progressive herniation can result in giant PEHs, which are associated with significant morbidity. This article presents the experience of an Asian acute care tertiary hospital in the management of giant PEH and parahiatal hernia. METHODS Surgical records dated between January 2003 and January 2013 from the Department of Surgery, Changi General Hospital, Singapore, were retrospectively reviewed. RESULTS Ten patients underwent surgical repair for giant PEH or parahiatal hernia during the study period. Open surgery was performed for four patients with giant PEH who presented emergently, while elective laparoscopic repair was performed for six patients with either giant PEH or parahiatal hernia (which were preoperatively diagnosed as PEH). Anterior 180° partial fundoplication was performed in eight patients, and mesh reinforcement was used in six patients. The electively repaired patients had minimal or no symptoms during presentation. Gastric volvulus was observed in five patients. There were no cases of mortality. The median follow-up duration was 16.3 months. There were no cases of mesh erosion, complaints of dysphagia or recurrence of PEH in all patients. CONCLUSION Giant PEH and parahiatal hernia are underdiagnosed in Asia. Most patients with giant PEH or parahiatal hernia are asymptomatic; they often present emergently or are incidentally diagnosed. Although surgical outcomes are favourable even with a delayed diagnosis, there should be greater emphasis on early diagnosis and elective repair of these hernias.
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Affiliation(s)
- Ye Xin Koh
- Upper Gastrointestinal Surgery Service, Department of Surgery, Changi General Hospital, Singapore
| | - Lester Wei Lin Ong
- Upper Gastrointestinal Surgery Service, Department of Surgery, Changi General Hospital, Singapore
| | - June Lee
- Upper Gastrointestinal Surgery Service, Department of Surgery, Changi General Hospital, Singapore
| | - Andrew Siang Yih Wong
- Upper Gastrointestinal Surgery Service, Department of Surgery, Changi General Hospital, Singapore
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Gálvez-Valdovinos R, Marín-Santillán E, Funes-Rodríguez JF, López-Ambriz G. [Laparoscopic gastric sleeve in gastric volvulus secondary to diaphragmatic eventration in an adult patient]. CIR CIR 2015; 84:140-3. [PMID: 26238590 DOI: 10.1016/j.circir.2015.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 11/19/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. CLINICAL CASE Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 hours after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. CONCLUSIONS Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus.
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Novel combined VATS/laparoscopic approach for giant and complicated paraesophageal hernia repair: description of technique and early results. Surg Endosc 2014; 29:185-91. [PMID: 24969852 DOI: 10.1007/s00464-014-3662-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The laparoscopic approach for repair of giant and/or recurrent paraesophageal hernias (PEH) is challenging, due to limited access to the dissection of the hernia sac into the proximal mediastinum and esophageal mobilization through the diaphragmatic hiatus. An esophageal lengthening procedure is often necessary, due to the difficulty in obtaining adequate intra-abdominal esophageal length. We, therefore, developed a VATS and laparoscopic technique, which allows for safe and extensive thoracic dissection and intra-abdominal gastric fixation and cruroplasty, yet preserving the benefits of minimally invasive surgery. METHODS We use a standard VATS approach. The hernia sac, optimally visualized, is dissected posteriorly from the thoracic aorta, inferiorly from its diaphragmatic attachments, anteriorly from the pericardium, and laterally from the mediastinal pleura. The esophagus is completely mobilized up to the aortic arch, and the anterior vagus nerve is released from its bronchial branches. The hernia sac is then opened, dissected, and completely removed. The hernia content is then reduced into the abdomen laparoscopically, the short gastric vessels are divided and the gastric fundus is completely mobilized. The hiatus is closed with interrupted sutures, and the cruroplasty is buttressed with a biological mesh. A floppy Nissen or a partial fundoplication and a gastropexy are done for reflux control and gastric fixation. RESULTS From January 2012 to January 2014, we treated 18 patients (7 with type III PEH and 11 with type IV) with the above-described procedure. Six patients had previous history of antireflux surgery. We performed a planned laparotomy instead of laparoscopy in two patients, who needed concurrent repair of complex incisional hernias. We did not need esophageal lengthening procedures, nor experienced damages to thoracic structures in any patient. CONCLUSIONS Our newly developed surgical approach has proven to be safe and feasible. This technique represents a good option for treatment of giant and complicated PEH.
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Toydemir T, Çipe G, Karatepe O, Yerdel MA. Laparoscopic management of totally intra-thoracic stomach with chronic volvulus. World J Gastroenterol 2013; 19:5848-5854. [PMID: 24124329 PMCID: PMC3793138 DOI: 10.3748/wjg.v19.i35.5848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the outcomes of patients who underwent laparoscopic repair of intra-thoracic gastric volvulus (IGV) and to assess the preoperative work-up.
METHODS: A retrospective review of a prospectively collected database of patient medical records identified 14 patients who underwent a laparoscopic repair of IGV. The procedure included reduction of the stomach into the abdomen, total sac excision, reinforced hiatoplasty with mesh and construction of a partial fundoplication. All perioperative data, operative details and complications were recorded. All patients had at least 6 mo of follow-up.
RESULTS: There were 4 male and 10 female patients. The mean age and the mean body mass index were 66 years and 28.7 kg/m2, respectively. All patients presented with epigastric discomfort and early satiety. There was no mortality, and none of the cases were converted to an open procedure. The mean operative time was 235 min, and the mean length of hospitalization was 2 d. There were no intraoperative complications. Four minor complications occurred in 3 patients including pleural effusion, subcutaneous emphysema, dysphagia and delayed gastric emptying. All minor complications resolved spontaneously without any intervention. During the mean follow-up of 29 mo, one patient had a radiological wrap herniation without volvulus. She remains symptom free with daily medication.
CONCLUSION: The laparoscopic management of IGV is a safe but technically demanding procedure. The best outcomes can be achieved in centers with extensive experience in minimally invasive esophageal surgery.
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Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD. Guidelines for the management of hiatal hernia. Surg Endosc 2013; 27:4409-28. [PMID: 24018762 DOI: 10.1007/s00464-013-3173-3] [Citation(s) in RCA: 267] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/02/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Geoffrey Paul Kohn
- Department of Surgery, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia,
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Jeong SH, Ha CY, Lee YJ, Choi SK, Hong SC, Jung EJ, Ju YT, Jeong CY, Ha WS. Acute gastric volvulus treated with laparoscopic reduction and percutaneous endoscopic gastrostomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:47-50. [PMID: 23833761 PMCID: PMC3699688 DOI: 10.4174/jkss.2013.85.1.47] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/14/2013] [Accepted: 02/12/2013] [Indexed: 11/30/2022]
Abstract
Acute gastric volvulus requires emergency surgery, and a laparoscopic approach for both acute and chronic gastric volvulus was reported recently to give good results. The case of a 50-year-old patient with acute primary gastric volvulus who was treated by laparoscopic reduction and percutaneous endoscopic gastrostomy is described here. This approach seems to be feasible and safe for not only chronic gastric volvulus, but also acute gastric volvulus.
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Affiliation(s)
- Sang-Ho Jeong
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea. ; Gyeongnam Regional Cancer Center, Gyeongsang National University, Jinju, Korea. ; Institue of Health Sciences, Gyeongsang National University, Jinju, Korea
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19
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[Laparoscopic treatment of acute gastric volvulus]. Cir Esp 2012; 91:189-93. [PMID: 22624957 DOI: 10.1016/j.ciresp.2012.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 03/05/2012] [Accepted: 03/09/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Gastric volvulus is an uncommon clinical condition and is associated with type ii-iii hiatal hernias. Its acute presentation constitutes a surgical emergency. Despite its low frequency, results of laparoscopic treatment have already been published. MATERIAL AND METHODS A retrospective study was performed on all cases diagnosed with gastric volvulus undergoing laparoscopic surgery between 1998 and 2010. The surgical technique, the post-operative outcome, and the clinical follow-up are described. RESULTS A total of 10 cases were identified, one was a primary gastric volvulus, and the remainder were secondary. A laparoscopic anterior gastropexy as the sole procedure was performed on 7 patients. A Nissen fundoplication with mesh reinforcement of the crural closure was performed on the 3 remaining cases. Postoperative outcome was uneventful in 9 patients, with an early start of the diet, and hospital discharge between 48-72 h. After a mean follow-up period of 18 months, radiological hernia recurrence occurred in one case but recurrence of the volvulus was not observed. CONCLUSION Laparoscopic anterior gastropexy is, in our experience, an effective and safe procedure with a low morbidity, for the treatment of acute gastric volvulus in patients with high surgical risk.
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Upside-down stomach - results of mini-invasive surgical therapy. Wideochir Inne Tech Maloinwazyjne 2011; 6:231-5. [PMID: 23255985 PMCID: PMC3516952 DOI: 10.5114/wiitm.2011.26257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 10/15/2011] [Accepted: 10/22/2011] [Indexed: 11/17/2022] Open
Abstract
AIM The authors evaluate the results of mini-invasive therapy in patients diagnosed with upside-down stomach. MATERIAL AND METHODS From 1998 to 2008, a total of 27 patients diagnosed with upside-down stomach were surgically treated at the 1st Department of Surgery, University Hospital Olomouc. Before the operation, patients were examined endoscopically and a barium swallow was performed. In all 27 patients (100%), the operation was performed electively laparoscopically. The principle of the operation in all cases was reposition of the stomach into the abdominal cavity, resection of the hernial sac and hiatoplasty. In addition, in 15 patients (56%) with reflux symptoms or endoscopic findings of reflux oesophagitis, fundoplication in Nissen's modification was also performed. Fundopexy was indicated in 12 patients (44%). RESULTS In all patients (100%), the operation was performed mini-invasively; conversion to an open procedure was never necessary. In 3 cases (11%), the left pleural cavity was opened during the operation; this was treated by introducing a chest drain. The operation mortality in the patient set was zero; morbidity was 11%. A year after the operation, patients were re-examined, and follow-up endoscopy and barium swallow were performed. CONCLUSIONS In all patients diagnosed with upside-down stomach, surgical treatment is indicated due to the risk of developing severe complications. Mini-invasive surgical therapy in the hands of an experienced surgeon is a safe procedure which offers patients all the benefits of mini-invasive therapy with promising short- and long-term results.
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Al-Salem AH. Congenital paraesophageal hernia with intrathoracic gastric volvolus in two sisters. ISRN SURGERY 2011; 2011:856568. [PMID: 22084782 PMCID: PMC3201063 DOI: 10.5402/2011/856568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/21/2011] [Indexed: 11/23/2022]
Abstract
Congenital paraesophageal hernia is rare in infants and children. This paper describes our experience with seven infants and children with congenital paraesophageal hernia with emphasis on two sisters who presented with unusually large paraesophageal hernias and herniation of most of the stomach resulting in intrathoracic gastric volvolus. The literature on the subject is also reviewed.
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Affiliation(s)
- Ahmed H Al-Salem
- Department of Pediatric Surgery, Maternity and Children Hospital, P.O. Box 61015, Qatif, Dammam 31911, Saudi Arabia
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Miscellaneous disorders and their management in gastric surgery: volvulus, carcinoid, lymphoma, gastric varices, and gastric outlet obstruction. Surg Clin North Am 2011; 91:1123-30. [PMID: 21889033 DOI: 10.1016/j.suc.2011.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article focuses on less common diseases that surgeons are called on for management options. Five topics-volvulus, carcinoid, lymphoma, gastric varices, and gastric outlet obstruction from peptic ulcer disease-are frequently used to evaluate surgical knowledge. Knowledge of these topics is useful for residents preparing for an in-training examination or board certification. Patients with these diseases require multidisciplinary management with oncologists and/or gastroenterologists, and mastery of these topics allows surgeons to effectively participate in the multidisciplinary care of these patients and advocate for surgical management when appropriate.
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Inaba K, Sakurai Y, Isogaki J, Komori Y, Uyama I. Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach. World J Gastroenterol 2011; 17:2054-7. [PMID: 21528087 PMCID: PMC3082762 DOI: 10.3748/wjg.v17.i15.2054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 09/27/2010] [Accepted: 10/04/2010] [Indexed: 02/06/2023] Open
Abstract
Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal hernia, volvulus, and gastroesophageal reflux.
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24
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Laparoscopic management of neonatal paraesophageal hernia with intrathoracic gastric volvulus. J Pediatr Surg 2010; 45:E21-3. [PMID: 20713199 DOI: 10.1016/j.jpedsurg.2010.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 05/22/2010] [Accepted: 05/25/2010] [Indexed: 11/23/2022]
Abstract
Intrathoracic gastric volvulus associated with neonatal paraesophageal hernia is very rare in the newborn period. We report a case of a 3-week-old term infant who presented to the hospital with a history of non-bilious vomiting. Workup for hypertrophic pyloric stenosis eventually revealed the presence of a congenital hiatal hernia and intrathoracic gastric volvulus requiring urgent surgical management. The infant underwent successful laparoscopic repair. We discuss the diagnosis and management of this extremely rare surgical cause of neonatal nonbilious emesis.
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A combined laparoscopic and endoscopic approach to acute gastric volvulus associated with traumatic diaphragmatic hernia. Surg Laparosc Endosc Percutan Tech 2008; 18:151-4. [PMID: 18427332 DOI: 10.1097/sle.0b013e3181659221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the article was to describe a comprehensive approach to laparoscopic repair of acute intrathoracic gastric volvulus in acquired diaphragmatic hernia. BACKGROUND Traumatic diaphragmatic hernias are observed in 10% of diaphragmatic injuries, which include blunt trauma, penetrating trauma, and iatrogenic injuries. It is of utmost importance because of its high morbidity and mortality. Minimally invasive approaches are considered to be safe and effective procedures. They also provide rapid recovery from the operation, avoid the morbidity of laparotomy, and allow rapid recovery of gastric function. METHOD From June 2002 to June 2006, we encountered 4 cases of acquired diaphragmatic hernia with acute gastric volvulus, which were successfully treated with laparoscopic reduction, detorsion, repair of diaphragmatic hernial defect, and percutaneous endoscopic gastropexy. RESULTS There were no operative complications. All 4 patients tolerated the procedure well and the patients were discharged 1 to 3 days after the operation. After 1 to 2 years of follow-up, there were no radiologic recurrences of the volvulus and all patients remained asymptomatic. CONCLUSIONS Laparoscopic surgery represents a safe and acceptable approach in the treatment of acute gastric volvulus through the abdominal approach with minimal morbidity and good outcome.
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Bedioui H, Bensafta Z. Volvulus gastrique: diagnostic et prise en charge thérapeutique. Presse Med 2008; 37:e67-76. [PMID: 17587536 DOI: 10.1016/j.lpm.2007.03.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 02/23/2007] [Accepted: 03/06/2007] [Indexed: 12/16/2022] Open
Abstract
Gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes. It is a diagnostic emergency and therapeutic challenge because in acute forms it may lead to gastric strangulation with a high risk of ischemia and necrosis. Organoaxial and mesentericoaxial volvulus are distinguished according to the direction of rotation. The most common cause of gastric volvulus is hiatal hernia, but the principal predisposing factor is ligamentous laxity. The diagnosis is suspected when erect chest radiograph images show a high air-fluid level in the chest. Moreover a barium swallow is essential to confirm the diagnosis. Nonetheless, a computed tomography (CT) scan now provides a comprehensive description of the thoracic lesion, including stomach vitality. Gastric volvulus requires surgical treatment, specifically volvulus reduction, reintegration of the stomach into the abdominal cavity in cases of intrathoracic migration, and correction of causal factors. Resection of the hernial sac and the role of gastropexy for preventing recurrence remain controversial. Advances in laparoscopic surgery have made possible a laparoscopic approach to most cases of chronic gastric volvulus.
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Affiliation(s)
- Heykal Bedioui
- Service de chirurgie A, Hôpital La Rabta, Tunis, Tunisie.
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Matsushima K, Kayo M, Hachiman H, Gushimiyagi M. Laparoscopic repair of gastric volvulus associated with wandering spleen in an adult: report of a case. Surg Today 2007; 36:843-5. [PMID: 16937293 DOI: 10.1007/s00595-006-3262-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Accepted: 05/16/2006] [Indexed: 11/29/2022]
Abstract
Gastric volvulus is an uncommon entity that may rapidly progress to infarction and necrosis of the stomach. We herein report the case of a 67-year-old man with acute gastric volvulus in association with wandering spleen. Following a reduction of the volvulus with a nasogastric tube, laparoscopic gastropexy was performed. Pediatric cases of gastric volvulus and a concurrent wandering spleen have been described, but to the best of our knowledge, no adult cases have previously been reported.
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Affiliation(s)
- Kazuhide Matsushima
- Department of Surgery, Okinawa Prefectural Chubu Hospital, 281 Miyazato, Uruma, Okinawa 904-2243, Japan
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Berindoague R, Targarona E, Pala X, Balagué C, Martinez C, Hernandez P, Agusti A, Sallent E, Mones J, Trias M. Unusual upper gastrointestinal diseases associated with achalasia: laparoscopic approach. Surg Endosc 2007; 21:719-23. [PMID: 17242987 DOI: 10.1007/s00464-006-9056-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 06/20/2006] [Accepted: 06/30/2006] [Indexed: 01/18/2023]
Abstract
BACKGROUND As a result of the high success rate associated with the laparoscopic approach for achalasia, surgery for the disease has become the treatment of choice in recent years. With the greater number of patients undergoing surgery, surgeons may encounter other upper gastroesophageal illnesses associated with achalasia, and these may require evaluation for simultaneous surgical treatment. This study aimed to evaluate the incidence of gastroesophageal diseases associated with achalasia, and to determine the possibility for simultaneous management using the laparoscopic approach. METHODS From January 1999 to May 2006, 81 patients were referred from the Service of Gastroenterology to the Service of General and Digestive Surgery as candidates for the surgical management of achalasia. Data for this group were recorded prospectively in laparoscopic surgery databases at the Hospital Sant Pau and the Hospital de Igualada. A total of 78 patients underwent laparoscopic Heller myotomy with gastric fundoplication. RESULTS In 8 of 81 patients, nine additional gastroesophageal diseases (11.1%) were found: three cases of pseudoachalasia (3.7%), three cases of paraesophageal hiatal hernia (3.7%), two cases of esophageal diverticulum (2.5%), and one case of gastric volvulus (1.2%). Pseudoachalasia was diagnosed for three patients. The diagnosis was made preoperatively for one of these patients. For the other two patients, an adenocarcinoma arising from the gastroesophageal junction was diagnosed during the laparoscopy. In three cases, a paraesophageal hiatal hernia was found and treated by laparoscopic Heller myotomy, sac excision, hiatal closure, and posterior fundoplication. Esophageal diverticulectomy was performed for one patient. Another patient presented with an organoaxial gastric volvulus associated with achalasia, for which laparoscopic Heller myotomy, posterior fundoplication, and anterior gastropexy were performed. The median follow-up period was 39 months, with no recurrence. CONCLUSIONS Despite their infrequency, several gastroesophageal diseases may be found in association with achalasia. Laparoscopic surgery may be useful for the diagnosis and/or treatment of both diseases.
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Affiliation(s)
- R Berindoague
- Service of General and Digestive Surgery, Hospital San Pau, Barcelona, Spain.
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Testini M, Vacca A, Lissidini G, Di Venere B, Gurrado A, Loizzi M. Acute intrathoracic gastric volvulus from a diaphragmatic hernia after left splenopancreatectomy: Report of a case. Surg Today 2007; 36:981-4. [PMID: 17072719 DOI: 10.1007/s00595-006-3281-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2004] [Accepted: 03/15/2005] [Indexed: 12/01/2022]
Abstract
Intrathoracic gastric volvulus is a rare event. It occurs when the stomach undergoes organoaxial torsion in the chest, caused either by concomitant enlargement of the hiatus or by a diaphragmatic hernia. A delay in diagnosis and treatment can result in fatal complications such as gastric ischemia, perforation, and hemorrhage. We report a case of intrathoracic localization of an acute and incarcerated organoaxial gastric volvulus caused by a left-sided diaphragmatic hernia resulting from a diaphragmatic injury. The patient had undergone a left splenopancreatectomy 4 years earlier for non-Hodgkin's lymphoma. We performed an emergency left thoracotomy with reduction of the acute volvulus, resection of the adhesions, and exeresis of an inflammatory mass from the omentum, with good results. The mechanisms of volvulus and diaphragmatic hernia with the relative diagnostic and therapeutic implications are discussed after this case report.
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Affiliation(s)
- Mario Testini
- Department of Application in Surgery of Innovative Technologies, Section of General and Thoracic Surgery, University of Bari Medical School, Bari, 70124, Italy
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Batirel HF, Uygur-Bayramicli O, Guler S, Yildizeli B, Yuksel M. Laparoscopic Repair of a Gastric Volvulus Occurring as a Long-Term Complication of Left Pneumonectomy: Report of a Case. Surg Today 2007; 37:43-5. [PMID: 17186345 DOI: 10.1007/s00595-006-3339-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 06/07/2006] [Indexed: 10/23/2022]
Abstract
Gastric volvulus is an extremely rare late complication of pneumonectomy. We report the case of a 61-year-old man who presented with a 1-year history of progressive intolerance of solids and weight loss 33 years after a left pneumonectomy. Preoperative examinations showed a mesenteroaxial gastric volvulus. We performed a laparoscopic Toupet fundoplication and anterior gastropexy, following which his symptoms disappeared.
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Affiliation(s)
- Hasan Fevzi Batirel
- Department of Thoracic Surgery, Marmara University Hospital, Tophanelioğlu Cad. No:13-15, Altunizade, Istanbul 34660, Turkey
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Palanivelu C, Rangarajan M, Shetty AR, Senthilkumar R. Laparoscopic suture gastropexy for gastric volvulus: a report of 14 cases. Surg Endosc 2006; 21:863-6. [PMID: 17180266 DOI: 10.1007/s00464-006-9089-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Revised: 08/02/2006] [Accepted: 08/08/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Gastric volvulus is an uncommon condition that affects mostly older men. It occurs mainly as a result of congenital laxity of the stomach's attachments and might be accompanied by a diaphragmatic hernia. This sometimes causes the stomach to herniate into the thorax, giving rise to respiratory compromise. A patient can have acute or chronic disease. We present our series of 14 patients who were managed with simple laparoscopic suture gastropexy. METHODS We managed 14 patients with gastric volvulus during the past ten years; 2 patients had primary type and 12 had secondary type gastric volvulus. Elective surgery was performed for the ten patients with chronic volvulus and emergency surgery was done for the four patients with acute volvulus. One of the patients with diaphragmatic hernia was six months pregnant and presented with acute symptoms. RESULTS All patients recovered well from surgery, including the pregnant patient. The average hospital stay was five days; the pregnant woman was discharged on the sixth postoperative day. DISCUSSION Symptoms of chronic gastric volvulus resemble those of reflux disease, whereas the acute condition is a surgical emergency. Gastric volvulus is a rare disease, so chances of laparoscopic management are also rare. There are also combined endoscopic and laparoscopic approaches for treatment; even percutaneous endoscopic gastrostomy has been tried with good results. In secondary volvulus, the diaphragmatic defect has to be repaired, preferably with mesh. Gastropexy is performed in all cases. CONCLUSION Even though worldwide experience in laparoscopic surgery for gastric volvulus is limited, the results are encouraging. Based on our experience, laparoscopic management seems to be safe and feasible in acute and gastric volvulus.
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Lee TC, Liu KL, Lin MT, Wang HP. Unusual cause of emesis in an octogenarian: organoaxial gastric volvulus associated with paraesophageal diaphragmatic hernia. J Am Geriatr Soc 2006; 54:555-7. [PMID: 16551339 DOI: 10.1111/j.1532-5415.2006.00643_9.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Borenstein DA, Cameron BH, Walton JM, Fitzgerald PG, Habib Z. Laparoscopic Treatment for Pediatric Gastric Volvulus. ACTA ACUST UNITED AC 2004. [DOI: 10.1089/pei.2004.8.310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David A. Borenstein
- Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Brian H. Cameron
- Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - J. Mark Walton
- Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Peter G. Fitzgerald
- Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Zakaria Habib
- Division of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
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Targarona EM, Bendahan G, Carmen C, Garriga J, Trias M. Mallas en el hiato: una controversia no solucionada. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)78938-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Horstmann R, Klotz A, Classen C, Palmes D. Feasibility of surgical technique and evaluation of postoperative quality of life after laparoscopic treatment of intrathoracic stomach. Langenbecks Arch Surg 2003; 389:23-31. [PMID: 14625776 DOI: 10.1007/s00423-003-0437-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 10/08/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND Because of the risk of life-threatening complications, the discovery of a complete intrathoracic stomach demands urgent surgery with the aim of repositioning the stomach and gastropexy, and secondarily, to improve life quality. In this study the feasibility of surgical technique and postoperative quality of life after laparoscopic treatment of complete intrathoracic stomach has been evaluated. METHODS From June 1999 to December 2001 16 patients with an intrathoracic stomach (hiatus hernia Types IIB and III) were treated by laparoscopic techniques, including the repositioning of the stomach, hemi-fundoplication and anterior gastropexy. During the postoperative follow-up the recurrence rate and quality of life (Eypasch index) were evaluated. RESULTS All operations were performed laparoscopically without conversion, with a mean operating time of 155 min. Pleural injuries occurred in 31% of patients and pleural effusions in 38%, which required puncture in three cases. Complete follow-up showed no recurrences at a median of 14 months. The median quality of life index was 84.6 preoperatively and had significantly improved to 117.8 after the operation. CONCLUSION Laparoscopic access for the treatment of intrathoracic stomach represents a minimally invasive and safe treatment option for complete intrathoracic stomach, with a low level of perioperative morbidity and significant improvement in quality of life.
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Affiliation(s)
- R Horstmann
- Department of Surgery, Herz-Jesu Hospital of Münster, Westfalenstrasse 109, 48151 Münster, Germany.
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Shivanand G, Seema S, Srivastava DN, Pande GK, Sahni P, Prasad R, Ramachandra N. Gastric volvulus: acute and chronic presentation. Clin Imaging 2003; 27:265-8. [PMID: 12823923 DOI: 10.1016/s0899-7071(02)00549-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Diaphragmatic hernia may be congenital or traumatic in origin. Traumatic hernia may menifest immediately or several months/years after the incident. Congenital hernia usually manifests in the early years of life. Diaphragmatic hernia may be complicated by gastric volvulus. Acute gastric volvulus is surgical emergency where as chronic gastric volvulus presents with nonspecific abdominal symptoms. Diagnosis of gastric volvulus is difficult and is based on imaging studies. We describe four cases of diaphragmatic hernia complicated by gastric volvulus, diagnosed on imaging and managed surgically.
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Affiliation(s)
- Gamanagatti Shivanand
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
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