case_images: PMC6849156_01
case_images: CT showing the gastric volvulus.
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case_images: PMC6849156_01_gr1.jpg
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case_images: The scan showed a vastly dilated stomach with a transition line between the antral and fundic air bubbles due to a volvulus (Fig. 1).
case_images: CT showing intra-thoracic transverse colon and pancreas.
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case_images: PMC6849156_01_gr2.jpg
case_images: fig0010
case_images: The stomach, spleen, distal pancreas and transverse colon were within the left thoracic cavity, passing through a postero-lateral diaphragmatic defect measuring 6 x 6.7 cm, with resultant compression of the ipsilateral lung and a rightward mediastinal shift (Fig. 2).
case_images: Pendulum shaped incision over the diaphragm (upper), thoracoscopic port placement (lower).
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case_images: fig0015
case_images: The defect was widened with a 2 cm incision medially, resembling a pendulum arm (Fig. 3). Isolated right-lung ventilation greatly aided the insertion of ports as depicted in Fig. 3.
case_images: Drawing the stomach out of the diaphragmatic defect.
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case_images: PMC6849156_01_gr4.jpg
case_images: fig0020
case_images: This facilitated reduction of the stomach under gentle traction (Fig. 4).
case_images: Thoracic location of the spleen as visualised transabdominally through the defect after replacing the stomach in the abdomen.
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case_images: PMC6849156_01_gr5.jpg
case_images: fig0025
case_images: Close apposition of the abdominal viscera with the lung necessitated prudent use of energy with most dissection progressing in blunt fashion (Figs. 5, 6).
case_images: Adhesions between the lung and the stomach in the thorax.
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case_images: PMC6849156_01_gr6.jpg
case_images: fig0030
case_images: Close apposition of the abdominal viscera with the lung necessitated prudent use of energy with most dissection progressing in blunt fashion (Figs. 5, 6).
case_images: Combined thoracosopic and laparoscopic views of the spleen.
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case_images: PMC6849156_01_gr7.jpg
case_images: fig0035
case_images: At the end of adhesiolysis with reduction of all viscera (Fig. 7), the posterior lip of diaphragmatic defect was seen to consist of only a narrow rim of muscle and peritoneum (Fig. 8).
case_images: 15 x 15 bilaminar mesh placement.
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case_images: PMC6849156_01_gr9.jpg
case_images: fig0045
case_images: The laparoscopic team augmented defect closure by placing a 15 x 15 cm bilaminar mesh over the defect, fixing it to the diaphragm with interrupted nonabsorbable sutures (Fig. 9).
case_images: Post operative scan.
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case_images: PMC6849156_01_gr10.jpg
case_images: fig0050
case_images: A CT scan on the 2nd postoperative day showed full expansion of the left lung without any evidence of herniation (Fig. 10).