A Case of Gastric Ulcer Associated with Esophageal Hiatal Hernia Showing Upside-down Stomach, which Was Difficult to Distinguish from Malignancy.

Abstract

We experienced a rare case of severe stenosis within“Upside-down-stomach”due to esophageal hiatal hernia. We herein report this case with some literature. A 75-year-old women was admitted to our hospital because of dysphagia. CT revealed that the entire stomach dislocated toward the mediastinum and a thickened wall of the antrum of stomach. Upper gastrointestinal series showed an“upside-down stomach”with volvulus of stomach associated with an esophageal hiatal hernia. Gastrointestinal endoscopy showed no malignancy, group 1. Based on these findings, the patient was diagnosed with an esophageal hiatal hernia with ulcerative gastric tumor. We performed distal gastrectomy with D1 lymph-node dissection and repair of the esophageal hiatus and gastropexy. The ulcerative tumor was diagnosed as chronic gastric ulcer having no malignant cell histologically. The patient had a good postoperative course and was discharged with no complication. She is still alive with no recurrence.