Abstract
A male patient in his seventies was admitted to the hospital because of persisting back and hypochondriac pain. In the upper gastrointestinal series, the gastric fornix was present in the abdominal cavity but the pyloric antrum had herniated into the mediastinum with mesenteroaxial torsion. An abdominal CT scan showed the transverse colon to have prolapsed into the mediastinum. Esophageal hiatal hernia with an upside down stomach was diagnosed, and laparoscopic surgery was performed. At surgery, the transverse colon was found to be present in the abdominal cavity, and we returned the stomach to the abdominal cavity, followed by exposing a dilated opening of the hiatal hernia. It was difficult to pull the stomach and strip off the adhesions around the stomach, but simple crural closure and Nissen fundoplication could be performed laparoscopically. The postoperative course was uneventful, and the patient was discharged on the postoperative day 8. Laparoscopic surgery for the upside down stomach is difficult technically and has rarely been reported in Japan. It is desirable to perform such operations by surgeons who are skilled at laparoscopic surgery.
