Intrathoracic gastric volvulus with herniation of colon and omentum in a paraesophageal hernia is a rare

Herniation of stomach and other viscera has been reported in type IV paraesophageal hernia, leading to serious complications such as perforation of the viscera, bleeding and gastric volvulus. The laxity of the supportive ligaments and diaphragmatic defect predisposes to gastric rotation and also the herniation of viscera. The herniation of viscera and gastric volvulus may be asymptomatic or present with chronic intermittent reducible hernia progressing to acute obstruction, as happened in this patient. The patient’s symptoms depend on the degree of obstruction and twisting. Clinically upper abdominal pain, retching and inability to pass a nasogastric tube would lead to clinical suspicion of acute gastric volvulus, but when associated with herniation of colon and omentum, the picture may be more confusing. X-ray chest, endoscopy, CT scan, MRI scan, barium studies, all contribute to the diagnosis. Unusual Case