Page 25 - Journal of WALS

10.5005/jp-journals-10007-1158
Nitinkumar Bhajandas Borkar et al
CASE REPORT
Chronic Mesenteroaxial Gastric Volvulus and Congenital

Diaphragmatic Hernia: Successful Laparoscopic Repair

Nitinkumar Bhajandas Borkar, Nitin Pant, Satish Kumar Aggarwal

ABSTRACT abdomen but no tenderness. Bowel sounds were normal.
There was decreased air entry in the left lower lobe. Rest of
Gastric volvulus is a rare cause of recurrent abdominal pain in
children. Usually it is associated with diaphragmatic pathology. the examination was normal. Plain X-ray showed elevated
A 9-year-old boy presented with recurrent abdominal pain and left dome of diaphragm and a large air fluid level just
vomiting. Investigations confirmed a volved stomach in the left beneath it. Rest of the bowel gas pattern was normal.
chest and a left congenital diaphragmatic hernia (CDH).
Laparoscopic reduction and repair of CDH was performed Visualized lung fields were normal. A nasogastric tube could
successfully. The stomach was devolved and reduced into the be easily passed. About 500 ml gastric nonbilious fluid was
abdomen. No gastropexy was performed. The patient is aspirated with relief from distension. Eventration of
asymptomatic 2 years after surgery.
Traditional treatment of gastric volvulus has been derotation diaphragm with volvulus was suspected. A contrast
and gastropexy with the anterior abdominal wall. Our case shows enhanced computed tomographic (CT) scan showed a
that gastropexy may not be needed in all cases. Also, this is volved stomach with air fluid level in the left chest and
perhaps the first case to undergo laparoscopic repair of CDH diaphragmatic hernia (Fig. 1).
and gastric volvulus in pediatric population.
In view of associated gastric volvulus, laparoscopic
Keywords: Gastric volvulus, Congenital diaphragmatic hernia, approach was used rather than thoracoscopy. Under general
Laparoscopy.
anesthesia in supine position, a 10 mm primary port was
How to cite this article: Borkar NB, Pant N, Aggarwal SK. inserted by open technique. Pneumoperitoneum was created
Chronic Mesenteroaxial Gastric Volvulus and Congenital using 10 mm Hg pressure. Two working ports of 5 mm
Diaphragmatic Hernia: Successful Laparoscopic Repair. World
J Lap Surg 2012;5(2):102-104. each were inserted in the right and left upper abdomen
respectively. An epigastric port was inserted for retracting
Source of support: Nil
the liver. The left side was elevated to facilitate the
Conflict of interest: None declared operation. Additionally, the falciform ligament was hooked
up with a stitch. The left triangular ligament was taken down
INTRODUCTION to retract the left lobe of liver. A large posterolateral defect
Congenital diaphragmatic hernia (CDH) results from failure in the diaphragm was found, through which the stomach,
of pleuroperitoneal canal to close around 6th and 8th weeks spleen and part of small bowel and large bowel was
of gestation. Although neonatal presentation with respiratory herniating (Fig. 2). Intestines were reduced with gentle pull.
distress is common presentation, delayed presentation and The spleen was reduced with the help of the shaft of the
incidental detection is also well known. Association of CDH 5 mm Babcock forceps. The margins of the defect were
with mesenteroaxial volvulus of the stomach is also well
known. In children, mesenteroaxial is the most common
type of gastric volvulus and association with anatomic
1
defects is a rule. Although laparoscopic repair of CDH was
reported as early as 1995, there is no report of concomitant
2
correction of symptomatic gastric volvulus. Also the
traditional treatment of gastric volvulus has been reduction
and gastropexy. Here, we report a case of CDH with
mesenteroaxial gastric volvulus, which was managed
laparoscopically. No gastropexy was done.

CASE REPORT

A 9-year-old boy presented with history of episodic non-
bilious vomiting and recurrent colicky abdominal pain for
a year. There was no history of constipation, fever or a prior Fig. 1: CT chest showing left diaphragmatic hernia and
surgery. On examination there was fullness in upper gastric volvulus
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