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\begin{document}

\title{Upside-down stomach an extreme form of Para-oesophageal Hernia.}



\author[1]{Pascal Gavriilidis}%
\affil[1]{Royal Cornwall Hospitals NHS Trust}%


\vspace{-1em}



  
  \date{May 24, 2024}


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\selectlanguage{english}
\begin{abstract}
Upside-down stomach accounts for less than 5\% of hiatal hernia. It is
the rarest form of par oesophageal hernia and characterised by
herniation of the most gastric parts or entire stomach into the
posterior mediastinum {[}1{]}. It is classified as type 3.%
\end{abstract}%



\sloppy


\textbf{Upside-down stomach an extreme form of Para-oesophageal Hernia}
.

Paschalis \emph{Gavriilidis\textsuperscript{1}}

\textbf{Author affiliations}

Department of General Surgery, Causeway Hospital, Coleraine BT52 1HS, NI

\textbf{Corresponding author:} Paschalis Gavriilidis, Department of
Surgery, Causeway Hospital BT52 1HS, NI, email: pgavrielidis@yahoo.com

Abstract

Upside-down stomach accounts for less than 5\% of hiatal hernia. It is
the rarest form of par oesophageal hernia and characterised by
herniation of the most gastric parts or entire stomach into the
posterior mediastinum. It is classified as type 3 {[}Figure 1{]}.

A 75 years old woman presented to emergency department of district
hospital in Northern Ireland with one week history of vomiting,
epigastric abdominal pain. In particular, observations in admission were
blood pressure 99/54 mmHG, heart rate 70 beats, oxygen saturation 96\%,
temperature 36.5. Laboratory results were PH:7.50(7.36-7.44), arterial
O2: 9.40(11.3-14.6), arterial CO2:4.30(4.7-6)kPa, arterial
lactate:1.5(1.0-1.4)mmol/L, Serum creatine:1528(20-200)U/L, Urea:9.6,
AST:1858, ALT:1711 (5-33) U/L, Amylase:453(28-100)U/L, CRP:128, white
blood cells:12.300, Haemoglobin 91.

The admission diagnosis was acute kidney injury, patient required 4
litres of intravenous fluids and ongoing inotrope support. CT scan
demonstrated a large volume gastric hiatus hernia containing the body
and antrum of stomach and is seen with air-fluid levels within.
Oesophago-gastroduodenoscopy demonstrated para-oesophageal hernia and
patchy mucosal necrosis of the antrum. The described case demonstrates
an upside-down stomach which is an extreme form of paraesophageal hernia
in which the entire stomach has herniated and rotated upward through
into the mediastinum {[}1{]}.

Patient underwent distal third gastrectomy with Roux en-Y repair, and
repair of the diaphragm. She recovered uneventfully and discharged on
the twelve postoperative day.

\textbf{References}

Schiergens TS, Thomas MN, H\selectlanguage{ngerman}üttl TP, Thasler WE. Management of acute
upside-down stomach. BMC Surg. 2013 Nov 15;13:55. doi:
10.1186/1471-2482-13-55. PMID: 24228771; PMCID: PMC3830558.

\textbf{Acknowledgements:} None to declare

\textbf{Financial Disclosure or Funding:} This research did not receive
any specific grant from funding agencies in the public, commercial, or
not-for-profit sectors

\textbf{Conflict of interest:} None

\textbf{Consent for publication:} Written informed consent was obtained
from the patient to publish this report in accordance with the journal's
patient consent policy

\textbf{Figure1:} Characteristic image of upside-down stomach; it is an
extreme form of paraesophageal hernia in which the entire stomach has
herniated and rotated upward through the diaphragm into the mediastinum.
A large volume gastric hiatus hernia containing the body and antrum of
the stomach is seen with air-fluid level within. Left arrow points at
antrum and the right at oesophagus.\selectlanguage{english}
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