Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report
Introduction: Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the ga...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BioMed Central
2015
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| Online Access: | http://ir.unimas.my/id/eprint/9709/ http://ir.unimas.my/id/eprint/9709/1/Successful%20laparoscopic%20management%20of%20paraesophageal%20hiatal%20hernia%20with%20upside-down%20intrathoracic%20stomach%28abs%29.pdf |
| _version_ | 1848836627264176128 |
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| author | Sze, Li Siow Chee, Ming Wong Sze, Chee Tee |
| author_facet | Sze, Li Siow Chee, Ming Wong Sze, Chee Tee |
| author_sort | Sze, Li Siow |
| building | UNIMAS Institutional Repository |
| collection | Online Access |
| description | Introduction: Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical
entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach
adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the
abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a
patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that
this is the first case report from Southeast Asia.
Case presentation: A 55-year-old Chinese woman presented to us with symptoms suggestive of gastric outlet
obstruction for one year. A chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity,
where a diaphragmatic hernia was initially suspected. A computed tomography scan and barium swallow study
demonstrated the presence of a type III paraesophageal hernia with intrathoracic upside-down stomach. A laparoscopy
was performed and the herniated stomach was successfully reduced into the abdomen. The mediastinal part of the
hernial sac was excised. Adequate intraabdominal length of oesophagus was achieved after resection of the sac and
circumferential oesophageal dissection. A lateral releasing incision was made adjacent to the right crus to facilitate
crural closure. The diaphragmatic defect and the hiatal closure were covered with a composite mesh. A Toupet
fundoplication was performed to recreate the antireflux valve. She had an uneventful recovery. She had no relapse of
previous symptoms at her six-month follow-up assessment.
Conclusions: Laparoscopic repair of such a condition can be accomplished successfully and safely when it is
performed with meticulous attention to the details of the surgical technique. |
| first_indexed | 2025-11-15T06:26:46Z |
| format | Article |
| id | unimas-9709 |
| institution | Universiti Malaysia Sarawak |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T06:26:46Z |
| publishDate | 2015 |
| publisher | BioMed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | unimas-97092016-10-21T06:58:09Z http://ir.unimas.my/id/eprint/9709/ Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report Sze, Li Siow Chee, Ming Wong Sze, Chee Tee R Medicine (General) RD Surgery Introduction: Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia. Case presentation: A 55-year-old Chinese woman presented to us with symptoms suggestive of gastric outlet obstruction for one year. A chest radiograph showed an air bubble with air-fluid level in her left thoracic cavity, where a diaphragmatic hernia was initially suspected. A computed tomography scan and barium swallow study demonstrated the presence of a type III paraesophageal hernia with intrathoracic upside-down stomach. A laparoscopy was performed and the herniated stomach was successfully reduced into the abdomen. The mediastinal part of the hernial sac was excised. Adequate intraabdominal length of oesophagus was achieved after resection of the sac and circumferential oesophageal dissection. A lateral releasing incision was made adjacent to the right crus to facilitate crural closure. The diaphragmatic defect and the hiatal closure were covered with a composite mesh. A Toupet fundoplication was performed to recreate the antireflux valve. She had an uneventful recovery. She had no relapse of previous symptoms at her six-month follow-up assessment. Conclusions: Laparoscopic repair of such a condition can be accomplished successfully and safely when it is performed with meticulous attention to the details of the surgical technique. BioMed Central 2015 Article NonPeerReviewed text en http://ir.unimas.my/id/eprint/9709/1/Successful%20laparoscopic%20management%20of%20paraesophageal%20hiatal%20hernia%20with%20upside-down%20intrathoracic%20stomach%28abs%29.pdf Sze, Li Siow and Chee, Ming Wong and Sze, Chee Tee (2015) Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report. Journal of Medical Case Reports, 9 (49). pp. 1-6. ISSN 17521947 http://www.ncbi.nlm.nih.gov/ doi:10.1186/s13256-015-0519-6 |
| spellingShingle | R Medicine (General) RD Surgery Sze, Li Siow Chee, Ming Wong Sze, Chee Tee Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report |
| title | Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report |
| title_full | Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report |
| title_fullStr | Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report |
| title_full_unstemmed | Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report |
| title_short | Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: A case report |
| title_sort | successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report |
| topic | R Medicine (General) RD Surgery |
| url | http://ir.unimas.my/id/eprint/9709/ http://ir.unimas.my/id/eprint/9709/ http://ir.unimas.my/id/eprint/9709/ http://ir.unimas.my/id/eprint/9709/1/Successful%20laparoscopic%20management%20of%20paraesophageal%20hiatal%20hernia%20with%20upside-down%20intrathoracic%20stomach%28abs%29.pdf |