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18 October 2019 : Case report  Japan

Cardiopulmonary Impairments Caused by a Large Hiatal Hernia with Organoaxial Gastric Volvulus Showing Upside-Down Stomach: A Case Report

Unusual or unexpected effect of treatment, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology

Akira Umemura12ABEF*, Takayuki Suto1CD, Hisataka Fujiwara1CD, Kenichiro Ikeda13AF, Seika Nakamura1D, Megumi Hayano1B, Hiroyuki Nitta2DF, Takeshi Takahara2E, Yasushi Hasegawa2BC, Hirokatsu Katagiri2CF, Shoji Kanno2AC, Akira Sasaki2EF

DOI: 10.12659/AJCR.918191

Am J Case Rep 2019; 20:1530-1535

Abstract

BACKGROUND: Upside-down stomach (UDS) is the rarest type of hiatal hernia (HH), with organoaxial gastric volvulus. A large HH sometimes causes cardiopulmonary impairments owing to multiple factors.

CASE REPORT: We herein report a case of a large HH with UDS that had induced weight loss and severe cardiopulmonary dysfunction in a 74-year-old female patient who presented with shortness of breath, chest pain, severe anorexia, and weight loss of 5 kg over the 3 previous months. Chest X-ray and CT examination revealed that her heart was retracted on the right side, and the hernia contents had induced physical compression of the left lung on the cranial side. Spirometry revealed that the patient’s vital capacity (VC), percentage VC, and percentage forced expiratory volume (% FEV) at 1 s were 1.32 L, 60.2%, and 67.5%, respectively. A barium swallow test confirmed a diagnosis of HH with UDS. On the basis of these findings, we performed a laparoscopic Nissen procedure, which resulted in the patient’s dramatic recovery. Postoperative examinations showed that the stomach and heart were once again normally located, and the left lung had re-inflated. Postoperative spirometry dramatically improved.

CONCLUSIONS: A large HH causes cardiac and pulmonary compression due to mass effects and leads to cardiopulmonary dysfunction. For cases that have both a complicated HH and cardiopulmonary dysfunction owing to the mass effects of hernia contents, laparoscopic HH repair can be a good alternative procedure.

Keywords: Fundoplication, Heart Failure, Hernia, Hiatal, Aged, Anorexia, Chest Pain, Dyspnea, Heart, Laparoscopy, Lung, Spirometry, Stomach Volvulus, Vital Capacity

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923