Rolling (paraesophageal) hiatus hernia with organoaxial gastric volvulus
Diffuse pain in the epigastric region
CT abdomen and pelvis
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The gastric fundus herniates through the hiatus into the thorax. The gastroesophageal junction and the stomach have also herniated into the thorax. CT also shows the rotation of the stomach along its long axis. There are no signs of acute obstruction.
Para-esophageal hernia is a severe form of hiatal hernia that occurs in only 5% of cases. In this case we see a compound hiatal hernia, which is a combination of sliding hiatus hernia and a rolling (para-esophageal) hiatus hernia.
Organo-axial gastric volvulus is the more common gastric volvulus with the stomach rotated along its long axis. Acute gastric volvulus may present clinically with Borchardt's triad. In the chronic presentation it can be asymptomatic and diagnosis is usually incidental. It may also present with upper abdominal discomfort, pain during feeding or postprandial pain, early satiety and vomiting.