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EMERGENCY HIATAL HERNIA REPAIR WITH ISCHEMIC STOMACH
Arianna Vittori
*1,2, Andrés R. Latorre-Rodríguez
1,3, Andrew Keogan
1,4, Sumeet K. Mittal
1,41Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ; 2University of Padua, School of Medicine, Padova, Italy; 3Universidad del Rosario. Escuela de Medicina y Ciencias de la Salud, Bogotá D.C., Colombia; 4Creighton University School of Medicine, Phoenix, AZ
We present the surgical management of a patient with an incarcerated intrathoracic stomach associated with gastric wall ischemia. The patient with a known large paraesophageal hernia presented with abdominal pain and nausea. CT showed a thickened wall with gastric volvulus without signs of perforation. Endoscopy showed ischemic changes in the proximal stomach. After laparoscopic reduction into the abdomen, we saw a large area of ischemia with potential necrotic areas of the anterior fundus up to the EGJ. A decision was made to imbricate the gastric wall rather than proceed with resection and esophagojejunostomy, and a gastrostomy tube was placed. Endoscopy was performed on POD 3, 7, and 30.
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