Successful treatment of acute esophageal necrosis caused by intrathoracic gastric volvulus: Report of a case

Abstract

Gastric volvulus is a potentially lethal condition. We report a case of esophageal hiatal hernia with strangulation of the esophagus and stomach caused by gastric volvulus. A 79-year-old woman was admitted to our hospital in a state of shock, and investigations showed necrotic changes in most of her distal esophagus and gastric body. Thus, we performed an emergency total gastrectomy and transhiatal esophagectomy, followed 3 months later by successful reconstruction of the esophagus using the jejunum. Occasionally, a large hiatal hernia accompanies gastric volvulus; however, the extent of esophageal necrosis observed in this patient is very unusual. Although a large hiatal hernia is usually a chronic disorder, surgical treatment is recommended, considering the risk of serious complications.

Acute traumatic diaphragmatic ruptures: A retrospective study of 48 cases

“…12 Many investigative techniques have been described for the diagnosis of TDR, including plain chest X-ray, CT scan, USG, magnetic resonance imaging, upper gastrointestinal oral contrast study, diagnostic peritoneal lavage (DPL), fl uoroscopic evaluation of diaphragmatic motion, intraperitoneal injection of radioisotopes, laparoscopy, and video-assisted thoracic surgery. 6 The two techniques most commonly used are chest X-ray and CT scan.…”

Diaphragmatic rupture: a single-institution experience and review of the literature

“…In the literature, consistent with our results, it has been reported that only 25%-50% of the initial chest radiographs are diagnostic for BDR. [18,20] Furthermore, sensitivity of CT in diagnosing acute DR ranges between 33% and 83%, and its specificity ranges between 76% and 100%. [18,21] CT findings in acute DR are hemidiaphragmatic discontinuity, intrathoracic herniation of the abdominal content, and the dependent viscera sign.…”

“…[18,20] Furthermore, sensitivity of CT in diagnosing acute DR ranges between 33% and 83%, and its specificity ranges between 76% and 100%. [18,21] CT findings in acute DR are hemidiaphragmatic discontinuity, intrathoracic herniation of the abdominal content, and the dependent viscera sign. [22,23] In our series, CT revealed a DR in three of five stable polytraumatized patients.…”

“…[8,11] The rate of initially missed diaphragmatic injuries range from 12% to 66% after an acute trauma. [17,18] Many investigation techniques have been described for DR diagnosis, but no diagnostic method has a higher sensitivity or specificity than other methods; nonetheless, CT can be considered as the gold standard in an emergency setting in stable patients. [13,19] In our study, the two most commonly used techniques were chest X-ray and CT.…”

Gastric Volvulus Secondary to Paraesophageal Hernia Causing Gastric Necrosis and Perforation of the Gastroesophageal Junction

“…It is also important to recognize that patients with paraesophageal or sliding hiatal hernias are at an increased risk of developing gastric volvulus and potential necrosis in the appropriate clinical setting. And although a large hiatal hernia is usually a chronic disorder, surgical treatment is recommended, considering the risk of serious complications [11]. In our patient, the insidious onset and paucity of gastrointestinal symptoms, along with the nonspecific findings on CT abdomen, precluded a very early diagnosis.…”