Gastric necrosis secondary to gastric volvulus complicating hiatus hernia

Abstract

Acute gastric volvulus is a rare condition complicating 4% of hiatus hernias. It is a more or less complete rotation of the stomach around a transverse or longitudinal axis. It can lead to perforations due to ischemic gastric wall necrosis with very poor prognosis (30% of mortality). We here report the case of an 89-year old female patient with chronic bronchopathy, presenting with epigastralgias associated with vomiting which had progressed for 03 days. Physical examination showed febrile patient at 38.5 with dyspnea (SpO2 88% at room air). Her appearence suggested infection, the abdomen was soft, tender at the level of the epigastrium. Laboratory test showed SBI (WBCs= 22000, CRP= 80). Abdominal CT scan showed hiatus hernia associated with significant gastric distension with wall defect in the anterior face of the stomach associated with pneumatosis in the gastric wall. The patient underwent surgery using a median approach, which showed voluminous hiatus hernia containing the greater curvature of the stomach. Distended stomach was restored to its normal intra-abdominal position. The anterior face of the greater tuberosity was the seat of several areas of necrosis. Total gastrectomy with manual oesojejunal anastomosis associated with Roux-en-Y gastric bypass was performed. The postoperative course was complicated by acute respiratory distress syndrome (ARDS). The patient died on day 8 after emergency hospital admission. Gastric volvulus is a rare condition, which can lead to extremely severe consequences. CT scan allows for thoracic lesion assessment and to study stomach vitality. The treatment of choice is based on surgery.