A rare case of Type III gastric volvulus: Presentation and laparoscopic management

Introduction: Gastric volvulus is a surgical emergency and a recognized complication of hiatal hernia. Type III gastric volvulus is the rarest variant and is characterized by gastric rotation about both the organoaxial and mesenterioaxial axes. Presentation and management of Type III gastric volvulus is not well described in literature. Case Report: An 89-year-old male presented with eight hours of coffee-ground vomiting. The patient was hemodynamically stable and examination was unremarkable. Imaging confirmed a large gastric volvulus. Gastric decompression was performed endoscopically and laparoscopy confirmed a huge Type III gastric volvulus with complex rotation of the stomach about both the organoaxial and mesenterioaxial axes. The stomach and distal esophagus were laparoscopically mobilized to ensure adequate intra-abdominal esophageal length. Due to the very large diaphragmatic defect, crural opposition was not possible so the stomach Simeon Ngweso1, Anand Trivedi2, Senarath Werapitiya3 Affiliations: 1B.Pharm, MBBS, Resident Medical Officer, Surgical Department, Royal Perth Hospital, Perth, Western Australia, Australia; 2MBBS, MS (General Surgery), Advanced General Surgical Registrar, General Surgery Department, Bunbury Regional Hospital, Bunbury, Western Australia, Australia; 3MBBS, MS, FRCS, FRACS, General Surgery Consultant/Upper GI Consultant, General Surgery Department, Bunbury Regional Hospital, Bunbury, Western Australia, Australia. Corresponding Author: E-mail: simeon.ngweso@health. wa.gov.au Received: 14 August 2016 Accepted: 03 November 2016 Published: 02 December 2016 was fixed laparoscopically via gastropexy from the anterior abdominal wall to the diaphragm. The patient made an uneventful postoperative recovery. Three months follow-up confirmed no recurrent symptoms. Conclusion: Gastric volvulus is rare but life-threatening. Type III gastric volvulus is the rarest variant with limited description in literature. In this particular case, endoscopic decompression and laparoscopic reduction and fixation without fundoplication was a successful treatment modality.