Chronic Gastric Volvulus in Traumatic Hiatus Hernia Managed by Gastrostomy

Abstract

Gastric volvulus is a rare entity. It occurs more frequently in the elderly with a hiatus hernia and only in 10-20% in infants and children. We report a rare case of an elderly patient with chronic gastric volvulus in traumatic hiatus hernia after a severe injury of the chest. He had a medical history of diabetes mellitus, severe cardiopathy with pacemaker, chronic respiratory disease and six months ago a road accident with a severe injury of the chest. Gastric volvulus was diagnosed endoscopically, confirmed radiologically and managed operatively with fixation of the stomach by gastrostomy. The patient during the diagnostic approach and until the surgical procedure was managed by nasogastric tube without bilious backflow, intravenous fluid administration, balance of electrolyte and parenteral nutrition. The successful treatment of the gastric volvulus with a simple fixation of the stomach on the anterior abdominal wall justifies the decision to avoid an attempt of hiatus hernia repair particularly in an elderly patient with a high operative risk. However, a delayed diagnosis may be threatening to the patient ’ s life and what should be highlighted is the difficulty of the diagnosis and the management in rare cases, such as chronic volvulus of the stomach. doi: http://dx.doi.org/10.4021/jmc1041w