We report the case of a 68-year-old woman with a history of hypercholesterolemia, arthrosis and common symptoms of long-standing dysmotility-type dyspepsia.
She came to our hospital with severe epigastric pain accompanied by nausea and vomiting.
On physical examination, the patient was impressed with severe pain upon palpation of the epigastric region without peritonitis.
The laboratory analysis showed leukocytosis (15,860 leukocytes) with 86% neutrophils, with no other abnormalities.
A plain chest X-ray showed a large air bubble in the lower mediastinum with a hydroaerial level.
The tortico-abdominal CT shows herniated esophagogastric junction below the hiatus, with superior displacement of the gastric fundus, intrathoracic adjacent to the distal esophagus, findings compatible with fundus hernia possible fundus.
The suspicion of gastric volvulus associated with paraesophageal hernia is attempted nasogastric tube placement, without achieving it.
Urgent upper endoscopy showed an area of torsion at the proximal gastric level compatible with volvulus, without endoscopic return.
The patient underwent emergency surgery.
Through bilateral subcostal laparotomy, the hiatal region is closed, visualizing the left paraesophageal hernia orifice with herniation and torsion of the gastric fundus without data of ischemic suffering.
Reduction, gastric return and excision of the hernia sac were performed.
Hernia repair is performed with primary suture with a fundoplication according to the Toupet technique.
