Abstract
A 78-year-old woman was admitted to our hospital because of respiratory distress. The computed tomography scan showed volvulus of the stomach, in which almost the whole stomach had prolapsed into the mediastinum, a so-called “upside down stomach”. Positive pressure ventilation was needed for respiratory distress. Since nasogastric tube insertion and conservative management were not successful, emergency surgery was performed. She underwent laparoscopic repair including reduction of hernia content, excision of the sac, primary closure, and fundoplication (Toupet). Postoperatively, her cardiopulmonary dysfunction was prolonged. Chest X-ray showed a soft tissue shadow in the right lower mediastinum, and needle puncture showed what appeared to be old bloody discharge. After large esophageal hernia repair surgery, there is a risk of heart and lung compression by hematoma.
