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Case Reports and Images in Surgery

 
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Case Report
 
Gastric volvulus after laparoscopic Nissen fundoplication and hiatal closure performed due to giant hiatal hernia: A case report
Heini Savolainen1, Tiina Lehtimäki2, Tuomo Rantanen1
1Department of Surgery, Kuopio University Hospital, Box 100, 70029 KYS, Kuopio, Finland.
2Department of Radiology, , Kuopio University Hospital, Box 100, 70029 KYS, Kuopio, Finland.

Article ID: 100004Z12HS2015
doi:10.5348/Z12-2015-4-CR-4

Address correspondence to:
Tuomo Rantanen
Department of Surgery, Kuopio University Hospital
Kuopio
Finland Box 100
70029 KYS
Phone: +35817172029
Fax: +35817173599

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How to cite this article:
Savolainen H, Lehtimäki T, Rantanen T. Gastric volvulus after laparoscopic Nissen fundoplication and hiatal closure performed due to giant hiatal hernia: A case report. J Case Rep Images Surg 2015;1:13–16.


Abstract
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 post-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.

Keywords: Abdominal pain, Acute gastric volvulus, Epigastric pain, Gastric volvulus, Laparoscopic Nissen fundoplication, Management


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Author Contributions
Heini Savolainen – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tiina Lehtimäki – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Tuomo Rantanen – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Heini Savolainen et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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