Fundoplication intrathoracic migration associated with gastric organoaxial volvulus
| Autor: | Antonio Barranco-Moreno, María Eugenia Gómez-Rejano, Salvador Morales-Conde, Jean Marie Cadet-Dussort, María Socas-Macías, Cristina Méndez-García, María Dolores Casado-Maestre, Javier Padillo-Ruiz |
|---|---|
| Přispěvatelé: | Universidad de Sevilla. Departamento de Cirugía |
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Boerhaave syndrome medicine.medical_treatment Stomach Volvulus Fundoplication Abdominal cavity Nissen fundoplication Hiatal hernia Abdominal wall Postoperative Complications medicine Humans Ultrasonography Esophageal Perforation business.industry Gastroenterology General Medicine Middle Aged medicine.disease Dysphagia Surgery Volvulus medicine.anatomical_structure Hernia Hiatal Vomiting Radiography Thoracic medicine.symptom business Tomography X-Ray Computed |
| Zdroj: | idUS. Depósito de Investigación de la Universidad de Sevilla instname Revista Española de Enfermedades Digestivas v.104 n.10 2012 SciELO España. Revistas Científicas Españolas de Ciencias de la Salud |
| Popis: | A 49-year-old man presented at the emergency department for severe epigastric pain and a 48-hour episode of vomiting with a greatly affected general state. This is a patient diagnosed with Behcet’s disease and ankylosing spondylitis, operated for a hiatal hernia two months before his admission, where a laparoscopic Nissen fundoplication and pillars closure were performed. During the immediate postoperative period, he manifested a picture of vomiting and dysphagia after waking up from the anesthetic procedure. Both disappeared with corticosteroid administration. At the admission to the hospital, the patient showed clear signs of difficulty breathing, paleness, sweating, tachypnea, and tachycardia. On examination, we found no breath sounds in the right hemithorax, and the abdominal exploration revealed signs of rigidity of abdominal wall. Chest X-ray (Fig. 1). Our differential diagnosis stated hiatal hernia recurrence vs. secondary acute esophageal perforation for abdominal overpressure due to persistent nausea (Boerhaave syndrome). A thoraco-abdominal CT scan was requested (Fig. 2). An urgent surgery was performed, where we found a complete transhiatal migration from stomach to chest and an associated organoaxial volvulus, as well as a partially disrupted fundoplication. Once the herniated viscera were reintroduced in the abdominal cavity, a proper vascularisation was showed. The fundoplication was rebuilt and the pillars were approached. An abdominal drainage was inserted and removed 4 days after the postoperative period. |
| Databáze: | OpenAIRE |
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