Abstract
Upside-down stomach is a rare condition characterized by the occurrence of a gastric volvulus in a supradiaphragmatic hernia sac. In the present report, we describe a case of upside-down stomach with mesenteroaxial volvulus wherein both the stomach and transverse colon had prolapsed into the esophageal hiatal hernia sac ; the gastric volvulus and transverse colon herniation were successfully resolved by colonoscopy-assisted percutaneous endoscopic gastrostomy (PEG).
A 91-year-old woman presented with a three-month history of intermittent vomiting after ingestion of meals. Esophagogastroduodenoscopy indicated the presence of severe deformity of the stomach. Abdominal plain radiography indicated deviation of digestive tract gas that appeared to overlap the cardiac silhouette. Abdominal computed tomography indicated migration of the antrum and body of the stomach, as well as a part of the transverse colon, into the mediastinum. Upper gastrointestinal series indicated subtotal herniation of the stomach into the mediastinum in an inverted position ; only the gastric fornix was found to remain in the infradiaphragmatic position. Based on the above-mentioned findings, we diagnosed the patient with upside-down stomach with mesenteroaxial torsion. Although surgical repair is recommended in such cases, the present patient was considered unsuitable for surgery.
PEG has been reported as an alternative to standard surgical therapy in symptomatic patients with upside-down stomach. In the present case, as the transverse colon had prolapsed into the thoracic cavity, the transverse mesocolon may interfere with the puncture route. Therefore, to prevent complications, a colonoscope was inserted under X-ray fluoroscopy, and the transverse colon was pulled from the mediastinum into the abdominal cavity. The displaced stomach was endoscopically repositioned and anchored to the abdominal wall by PEG. Following the procedure, the symptoms of the patient resolved. At follow-up 1 year and 8 months later, we have confirmed her well-being and that she was symptom-free.
