Journal of

Case Reports and Images in Surgery

 
     
Case Report
 
A rare case of Type III gastric volvulus: Presentation and laparoscopic management
Simeon Ngweso1, Anand Trivedi2, Senarath Werapitiya3
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.

Article ID: 100034Z12SN2016
doi:10.5348/Z12-2016-34-CR-26

Address correspondence to:
Simeon Ngweso


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How to cite this article:
Ngweso S, Trivedi A, Werapitiya S. A rare case of Type III gastric volvulus: Presentation and laparoscopic management. J Case Rep Images Surg 2016;2:101–104.


Abstract
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 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.

Keywords: Gastric volvulus, Laparoscopic surgery, Laparoscopic management


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Author Contributions
Simeon Ngweso – 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
Anand Trivedi – 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
Senarath Werapitiya – 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
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
© 2016 Simeon Ngweso 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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