2020 Volume 48 Issue 3 Pages 139-148
The patient was a 79-year-old woman who visited a local physician because of persistent epigastric pain and vomiting that led to difficulty in oral ingestion and was referred to our hospital for further examination. Computed tomography scans of the chest and abdomen showed that the stomach and transverse colon had migrated into the mediastinum and an upside-down stomach with gastric volvulus in a mesenteroaxial fashion. Radiographic contrast of the upper gastrointestinal tract showed that the stomach was inverted and that the entire stomach had prolapsed into the mediastinum. Thus, the patient was diagnosed with type IV esophageal hiatal hernia with upside-down stomach, and laparoscopic repair was performed. The surgery was performed with the patient in an open-leg supine position with five ports. Surgical findings revealed an esophageal hiatal hernia that was approximately 80×60 mm, with invagination of the entire stomach and transverse colon within the mediastinum. After reduction of the prolapsed organ into the abdominal cavity, the diaphragmatic limb of the esophageal hiatus was closed with nonabsorbable sutures, and the esophageal hiatus was reinforced using mesh. Additionally, Toupet fundoplication was performed. The postoperative course was uneventful. Oral intake was initiated at postoperative day (POD) 4, after which oral intake stabilized, and the patient was transferred to a rehabilitation hospital on POD 20. Upside-down stomach is associated with gastric volvulus and situations where the stomach is highly prolapsed into the mediastinum are relatively rare. Here, we report a patient with type IV esophageal hiatal hernia with upside-down stomach that was repaired laparoscopically.
