Gastric volvulus after laparoscopic Nissen fundoplication and hiatal closure performed due to giant hiatal hernia: A case report

Introduction: More fundoplications are done because laparoscopic Nissen fundoplication is less invasive than open surgery. Although recovery after laparoscopic Nissen fundoplication is faster, and complications are fewer, than after open procedures, some potentially life-threatening complications can arise. Acute gastric volvulus is one of these and, because it is not a frequent event, its diagnosis is sometimes difficult. case report: A 60-year-old female came into the emergency department with severe epigastric pain, and vomiting followed by retching without the ability to vomit. In addition, a nasogastric tube could be passed only with the help of endoscope. Nissen fundoplication had been carried out due to a giant hiatal hernia four months earlier. On ct scan gastric volvulus was suspected with an otherwise intact Nissen fundoplication. the operation was started by laparoscopy, but, when untwisting of the stomach failed, an open laparotomy approach was adopted. During operation no anatomical failures or adhesions were found. Gastropexy with non-absorbable stitches was performed after the release of the volvulus. two stitches were placed between the fundus and hiatus, and two stitches between the stomach and peritoneum. the patient had a normal postoperative recovery and was discharged home on the sixth postHeini Savolainen1, Tiina Lehtimäki2, Tuomo Rantanen1 Affiliations: 1Department of Surgery, Kuopio University Hospital, Box 100, 70029 KYS, Kuopio, Finland; 2Department of Radiology, , Kuopio University Hospital, Box 100, 70029 KYS ,Kuopio, Finland. Corresponding Author: Tuomo Rantanen, Department of Surgery, Kuopio University Hospital, Kuopio, Finland Box 100, 70029 KYS; Ph:+35817172029; Fax:+35817173599 Received: 30 June Accepted: 04 August 2015 Published: 03 September 2015 operative day. At 24th month of follow-up she was symptomless. conclusion: Gastric volvulus can occur after Nissen fundoplication also with intact fundic wrap and without adhesions, which is now reported for the first time. Fast diagnosis of gastric volvulus is important in the acute form of the disease. Undiagnosed, it can lead to hemorrhage and strangulation, which are potentially fatal complications.