A Case of “Upside Down Stomach” with Chronic Respiratory Failure Relieved by Operation

Abstract

Although esophageal hiatal hernia is a disease that we often encounter, the disease which is associated with volvulus of the stomach and in which the almost whole stomach has prolapsed into the mediastinum, presenting so-called “upside down stomach (UDS)”, is rare. In this paper we present a case of an UDS with chronic respiratory failure which was able to be relieved by laparotmy.
The case involved a 65-year-old man who had a history of chronic respiratory failure and had been induced home oxygen therapy. He was admitted to our department because of hematemesis on an emergency basis. Chest and abdominal contrast-enhanced CT scan showed an extensively prolapsed stomach showing a volvulus into the mediastinum. Upper gastrointestinal endoscopy revealed a huge esophageal hiatal hernia. Accordingly UDS was diagnosed. Attempts of endoscopic repair failed to reduce the stomach and laparotmy was employed. Surgical procedures included reduction of the stomach, reinforcement of the esophageal hiatus, and cardioplasty. After the operation, respiratory function became improved and the patient did not require home oxygen therapy.
Recently we sometimes encounter cases of UDS in the literature, but the disease is so rare that only 32 cases have been reported in Japan. Some bibliographic comments are also presented here.