Upside Down Stomach Causing Intraperitoneal Bleeding—A Case Report—

Abstract

An 87-year-old woman was brought into the emergency department by ambulance for evaluation of hematemesis and melena. She was diagnosed with Mallory-Weiss syndrome following emergency upper gastrointestinal endoscopy ; however, post-endoscopy computed tomography revealed perisplenic ascites and an upside-down stomach (UDS). The patient was preoperatively diagnosed with intraperitoneal bleeding and underwent emergency laparotomy. Intraoperatively, we detected bleeding from the gastrosplenic mesentery. Therefore, we performed suturing and hiatal hernia repair to ensure hemostasis. Postoperatively, she developed stroke ; however, she improved and was transferred to a rehabilitation facility without recurrent UDS. In this case, UDS led to excessive stretching of the gastrosplenic mesentery, and the physical stimulus associated with vomiting and endoscopic manipulation resulted in gastrosplenic mesentery hemorrhage. Intraperitoneal hemorrhage associated with esophageal hiatal hernia is rare. We report a rare case of this clinical presentation, with a literature review.