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