Gastric volvulus is a rare but potentially life-threatening complication of a hiatal hernia that can result in gastric ischemia or necrosis if not promptly recognized and treated. A 51-year-old man presented with several hours of severe nausea, vomiting, and chest pain. Physical examination was notable for signs of acute distress, and the patient reported dark-colored emesis. Initial laboratory evaluation demonstrated leukocytosis and elevated serum lactate levels. Computed tomography of the chest and abdomen revealed a large hiatal hernia with herniation of the majority of the stomach into the thoracic cavity and findings concerning for mesoaxial gastric volvulus. Esophagogastroduodenoscopy demonstrated ischemic changes involving the gastric cardia. Given concern for gastric ischemia, the patient underwent urgent surgical intervention, including reduction of the hiatal hernia, cruroplasty reinforced with bio-synthetic mesh, and gastropexy to prevent re-torsion. The patient tolerated the procedure without intraoperative complications and demonstrated clinical improvement postoperatively, with resolution of symptoms and stabilization of laboratory abnormalities. This case highlights the importance of early recognition of gastric volvulus as a complication of a hiatal hernia and underscores the role of prompt imaging and surgical intervention to prevent gastric ischemia and necrosis.
Ladas et al. (Wed,) studied this question.