2025 Volume 45 Issue 5 Pages 515-518
The patient was an 85-year-old woman who presented with the symptoms of loss of appetite and vomiting while undergoing treatment for gastroesophageal reflux disease. Chest and abdominal CT revealed a hiatal hernia with an upside-down stomach and free air within the hernia sac, suggesting gastric perforation within the hernia sac. We performed emergency laparoscopic surgery; intraoperatively, we found complete gastric herniation into the mediastinum, with brown fluid and adhesions within the hernia sac. Rupture of the seromuscular layer at the gastric fundus exposing the submucosal layer was observed, however, there was no obvious perforation. We considered that the seromuscular layer of the stomach was ruptured due to the increase in internal pressure caused by vomiting, which was also attributed to the upside-down stomach. We performed laparoscopic partial gastrectomy, hiatal hernia repair, and fundoplication. After systemic postoperative care, the patient improved and she was discharged on the 34th day after surgery.
