A Case of Laparoscopic Surgery for an Esophageal Hiatal Hernia with an Upside–down Stomach

Abstract

We report a case of laparoscopic surgery performed for a patient with an esophageal hiatal hernia associated with an upside–down stomach, caused by gastric volvulus, which is a rare disorder. The patient was an 86–year–old woman who presented with a history of epigastralgia developing frequently after a meal, which had worsened gradually over time. Computed tomography (CT) showed that the stomach had rotated and invaginated into the mediastinum. We diagnosed the patient as having esophageal hernia with an upside–down stomach, and urgently hospitalized. She vomited black blood, and fiberoptic upper gastrointestinal endoscopy revealed impairment of the blood supply to the gastric corpus mucosa. As endoscopic repositioning proved difficult, we performed laparoscopic surgery. The esophageal hiatus was repaired, and gastropexy and Toupet fundoplication were performed. This patient became symptom–free after the operation.