Presentation
Vomiting and acute chest discomfort, status post surgery for hiatus hernia one week ago.
Patient Data
CT study with oral contrast shows a volvulus of herniated stomach twisted along its long axis. No perforation or collection or leak. The rest of the distal stomach and duodenum lie in normal intra-abdominal positions.
Moderate to large bilateral pleural effusions with collapse of the underlying lower lobes bilaterally. The mediastinum has been compressed anteriorly. Patchy areas of consolidation are present in both upper lobes as well.
Very extensive subcutaneous emphysema in the fat of the anterior and lateral thoracic and abdominal walls extending up to the upper thighs bilaterally, likely related to the laparoscopic procedure.
Case Discussion
This is a compound type of hiatus hernia with twisting of the stomach along its long axis resulting in organo-axial gastric volvulus.
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