Gastric obstruction secondary to abdominal re-herniation of a giant hiatal hernia. An illustrative case to understand the pathophysiology of gastric volvulus

Abstract

Purpose: To depict the characteristics of a special type of gastric volvulus caused by acute re-herniation of a previous hiatal hernia. Materials and methods: We present the case of a male patient with known history of a giant hiatal hernia who presented to our emergency department with a chief complaint of epigastric pain, oral intolerance and incoercible vomiting in the last 24 h. On suspicion of abdominal complication, an emergent computed tomography (CT) scan was performed. Results: Gastric volvulus secondary to downward re-herniation of the fundus into the abdominal cavity was the cause of this patient's symptoms. This mechanism, which was demonstrated by comparing the CT findings of the acute episode with previous imaging studies, reveals a largely unrecognized pathogenic mechanism of gastric volvulus. Conclusions: Acute gastric volvulus should be suspected in patients with hiatal hernia. CT allows its diagnosis and likely underlying pathophysiological mechanism.