Gastric Volvulus Secondary to Paraesophageal Hernia Causing Gastric Necrosis and Perforation of the Gastroesophageal Junction

Abstract

Gastric volvulus is a potentially lethal condition with significant morbidity and mortality if not recognized and managed promptly and appropriately. We report a case of gastric volvulus secondary to paraesophageal hernia causing gastric necrosis and perforation of the gastroesophageal junction. An 82-year-old woman with a large paraesophageal hernia was admitted to our hospital with vague epigastric and right-sided chest pain. She was taken to surgery and laparotomy findings included a large paraesophageal hernia, gastric volvulus with ischemia, frank gangrene and perforation at the gastroesophageal junction. She underwent reduction of the hernia and gastric volvulus with partial gastroesophagectomy and formation of an esophagogastrostomy anastomosis. Due to the patient’s old age and associated co-morbidities, her prognosis remained poor post-operatively and she was transferred to hospice care as per family wishes. This case report is intended to educate clinicians to maintain a high index of suspicion for acute gastric volvulus and its potential complications in the appropriate clinical setting to allow for early surgical intervention and appropriate management.