Rupture spontanée de l'œsophage: complication inhabituelle d'une hernie hiatale avec volvulus gastriqueSpontaneous rupture of the esophagus: an unusual complication of a hiatus hernia associated with a gastric volvulus

Gastric volvulus is a surgical emergency that requires prompt recognition and management. The acromegalic patient has a number of pathophysiological factors that predispose to gastric volvulus and slow gastrointestinal (GI) transit. Authors aimed to present a case of hiatus hernia and gastric volvulus in a patient with acromegaly and review the current literature on GI anomalies in this population. A 70-year-old female presented to our institute with epigastric pain and coffee-ground vomiting on the background of acromegaly secondary to pituitary adenoma (resected in 1997). She was found to have a gastric volvulus and hiatus hernia which was repaired laparoscopically. She was discharged home but re-presented six days later with abdominal distension and vomiting. Computed tomography (CT) scan of abdomen showed recurrent gastric volvulus with involvement of the transverse colon. She underwent a laparotomy but no evidence of gastric or colonic volvulus was seen intra-operatively. The CT findings were attributed to a large stomach and coiled redundant transverse colon which could be misinterpreted as volvulus on imaging. Gastroparesis and slow bowel transit were the likely aetiology of this second presentation. This is consistent with literature reporting slow bowel transit and dolichocolon in acromegalic patients. Gastric volvulus is a rare finding associated with acromegaly. Structural anomalies in the anatomy of the acromegalic patient can make CT diagnosis challenging. This case demonstrates the need for caution when interpreting imaging in this cohort, as well as the need for further research on GI pathology associated with acromegaly.

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Perforation of gastric volvulus within a giant hiatus hernia secondary to alendronate: A rare complication of bisphosphonate use

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2020.06.068 ◽

2020 ◽

Vol 73 ◽

pp. 5-8 ◽

Cited By ~ 1

Author(s):

Bianca Kwan ◽

Jason Wong

Keyword(s):

Hiatus Hernia ◽

Rare Complication ◽

Gastric Volvulus

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Acute gastric volvulus with pneumatosis intestinalis and portal venous gas secondary to hiatus hernia induced gastric outlet obstruction

ANZ Journal of Surgery ◽

10.1111/ans.14984 ◽

2019 ◽

Vol 89 (12) ◽

Author(s):

Lee S. Kyang ◽

Raj Srinivasan ◽

Vivek Singh

Keyword(s):

Gastric Outlet Obstruction ◽

Hiatus Hernia ◽

Gastric Volvulus ◽

Outlet Obstruction ◽

Pneumatosis Intestinalis ◽

Portal Venous Gas ◽

Acute Gastric Volvulus

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Surgical management of hiatus hernia with chronic gastric volvulus: report of two cases

Esophagus ◽

10.1007/s10388-009-0219-7 ◽

2010 ◽

Vol 7 (1) ◽

pp. 59-63 ◽

Cited By ~ 3

Author(s):

Toru Obuchi ◽

Akira Sasaki ◽

Jun Nakajima ◽

Shigeaki Baba ◽

Yusuke Kimura ◽

...

Keyword(s):

Surgical Management ◽

Hiatus Hernia ◽

Gastric Volvulus

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Chronic Gastric Volvulus in Traumatic Hiatus Hernia Managed by Gastrostomy

Journal of Medical Cases ◽

10.4021/jmc1041w ◽

2013 ◽

Author(s):

Andromanakos

Keyword(s):

Hiatus Hernia ◽

Gastric Volvulus

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Beyond Belsey: complex laparoscopic hiatus and diaphragmatic hernia repair

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0183 ◽

2019 ◽

Vol 101 (3) ◽

pp. 162-167 ◽

Cited By ~ 2

Author(s):

D Zanotti ◽

C Fiorani ◽

A Botha

Keyword(s):

Diaphragmatic Hernia ◽

Hiatus Hernia ◽

Intraoperative Complications ◽

Gastric Volvulus ◽

Laparoscopic Approach ◽

Acute Presentation ◽

Different Types ◽

The Right ◽

Diaphragmatic Hernia Repair

Background Diaphragmatic and hiatus hernias can cause mild chronic symptoms or have an acute presentation with gastric volvulus and obstruction. Elective or emergency surgery is indicated in symptomatic patients and nowadays is generally performed laparoscopically. Methods We report four different types of hernias: a giant hiatus hernia following a gastric pull-up for recurrent congenital diaphragmatic hernia; a Bochdalek hernia in a pregnant young woman; concomitant hiatus and Morgagni hernias; and a giant hiatus hernia occupying the right chest. All were approached laparoscopically, either electively or as an emergency. Results Surgery led to a resolution of symptoms in all the cases. We had no any intraoperative complications. Two patients developed minor postoperative complications (chest infection). No recurrences were found during a mean follow-up of 18 months. Conclusions Transabdominal laparoscopic approach is a safe and feasible approach to all cases of symptomatic hiatus and diaphragmatic hernia.

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