CT - Pre-operative
The pre-appendicectomy CT study confirms a compound or mixed para oesophagal hiatal hernia (type 4). There is complete gastric herniation with an abnormal rotation, however no gastric outlet obstruction and hence no gastric volvulus. There is herniated mesenteric fat, with small and
large bowel. There is adjacent atelectasis as expected. There is no diaphragmatic rupture.
There is peri splenic-free fluid in a setting of complicated acute appendicitis.