Year 2012 / Volume 104 / Number 10
Digestive Diseases Image
Fundoplication intrathoracic migration associated with gastric organoaxial volvulus

pp. 546-547

María Dolores Casado Maestre, María Socas Macías, Salvador Morales-Conde, Cristina Méndez García, Antonio Barranco Moreno, Jean Marie Cadet Dussort, Javier Padillo Ruiz y María Eugenia Gómez Rejano

Abstract
A 49-year-old man presented at the emergency department for severe epigastric pain and a 48-hour episode of vomiting with a greatly affected general state. This is a patient diagnosed with Behçet’s disease and ankylosing spondylitis, operated for a hiatal hernia two months before his admission, where a laparoscopic Nissen fundoplication and pillars closure were performed. During the immediate postoperative period, he manifested a picture of vomiting and dysphagia after wak- ing up from the anesthetic procedure. Both disappeared with corticosteroid administration.
At the admission to the hospital, the patient showed clear signs of difficulty breathing, paleness, sweating, tachypnea, and tachycardia. On examination, we found no breath sounds in the right hemithorax, and the abdominal exploration revealed signs of rigidity of abdominal wall. Chest X-ray (Fig. 1).
Our differential diagnosis stated hiatal hernia recurrence
vs. secondary acute esophageal perforation for abdominal Fig. 1. It reveals the presence of a right hydropneumothorax with com-
overpressure due to persistent nausea (Boerhaave syndrome). pressive atelectasis of the lung and contralateral mediastinal shift. A thoraco-abdominal CT scan was requested (Fig. 2).
An urgent surgery was performed, where we found a complete transhiatal migration from stomach to chest and an associated organoaxial volvulus, as well as a partially disrupted fundoplication. Once the herniated viscera were reintroduced in the abdominal cavity, a proper vascularisation was showed. The fundoplication was rebuilt and the pillars were approached. An abdominal drainage was inserted and removed 4 days after the postoperative period.
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María Dolores Casado Maestre, María Socas Macías, Salvador Morales-Conde, Cristina Méndez García, Antonio Barranco Moreno, Jean Marie Cadet Dussort, Javier Padillo Ruiz y María Eugenia Gómez Rejano. Fundoplication intrathoracic migration associated with gastric organoaxial volvulus. 546-547


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