An Esophageal Hiatal Hernia Associated with Heart Failure, Gallbladder Perforation and Mesenteroaxial Gastric Volvulus -A Case Report-

Toshio Okabe, Fumio Watanuki, Susumu Ohwada* and Yasuo Morishita*

Department of Surgery, Watanuki Hospital
Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine*

We report a case in which the entire stomach prolapsed into a large esophageal hiatal hernia with mesenteroaxial gastric volvulus, resulting in acute congestive heart failure and cholecystitis with perforation. A 79-year-old woman admitted for epigastric and back pain and dyspnea was found in chest X-ray showed pulmonary congestion and an air bubble in the mediastinum. Ultrasonography and abdominal computed tomograms (CT) showed a swollen gallbladder with a thick wall. Under a diagnosis of esophageal hiatal hernia, acute cholecystitis, and acute congestive heart failure, we conducted conservative treatment. Heart failure improved after 3 and abdominal pain after 7 days. An upper gastrointestinal series showed that the entire stomach had migrated into the mediastinum with mesenteroaxial gastric volvulus. Abdominal CT showed a cystic lesion near the lateral lobe of the liver. Surgical treatment was selected under a diagnosis of esophageal hiatal hernia with volvulus and gallbladder perforation. The stomach prolapsed into the mediastinal hernial sac and the gallbladder was perforated with a "bile lake" near the lateral lobe of the liver, triangular ligament, and stomach. A cholecystectomy and Nissen fundoplication were done, and her postoperative course has been uneventful in the 3 years since surgery.

Key words
esophageal hiatal hernia, gallbladder perforation, mesenteroaxial gastric volvulus

Reprint requests
Toshio Okabe Department of Thoracic and Visceral Organ Surgery, Gunma University Graduate School of Medicine
3-39-15 Showa-machi, Maebashi, 371-8511 JAPAN

Accepted
April 26, 2006

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