Giant diaphragmatic hernia with intrathoracic gastric volvulus.

The traditional surgical management of gastric volvulus consists of laparotomy with gastric detorsion and fixation, and diaphragmatic hernia repair. We report here an 83−year−old patient whose gastric volvulus occurred through a giant dia− phragmatic defect (Figure 1), who pre− sented with a 1−week history of abdomi− nal pain, distension, vomiting, and dys− phagia. At surgery, the gastroesophageal junction, the fundus and distal half of the stomach, and the omentum were found in the thorax, and an intrathoracic orga− noaxial gastric volvulus through a hiatal hernia was diagnosed (Figure 2). We pro− ceeded to laparoscopic herniated organ reduction, excision of the hernial sac, mo− bilization of the fundus, crural repair, and a Nissen fundoplication and gastropexy. The patient was well and had no hernia recurrence at 1−year follow−up (Figure 3).