PMC3934612_01
a, b After inserting the gastroscope into the duodenum, the stomach was reduced to the normal anatomic position. c The anterior stomach wall was fixed to the abdominal wall by stomach wall fixture. d Endoscopic findings showed the stomach wall fixed in three places (arrows).
crg-0008-0032-g01.jpg
PMC3934612_01_crg-0008-0032-g01.jpg
F1
The stomach was reduced to the normal anatomic position, and the anterior stomach wall was fixed to the abdominal wall in three places as widely as possible (fig. 1).
Findings of chest and abdominal computed tomography. a The cardia (arrow) and the gastric fornix were present in the normal position, and the stomach was dilated significantly. b The gastric corpus was displayed above the diaphragm.
crg-0008-0032-g02.jpg
PMC3934612_01_crg-0008-0032-g02.jpg
F2
Chest and abdominal computed tomography showed the gastric fornix in the abdominal cavity, but the gastric corpus was above the diaphragm with organoaxial volvulus (fig. 2).
Intraoperative findings. a The anterior stomach wall was adhered to the abdominal wall in three places from the antrum to the lower corpus of the stomach. b The upper corpus of the stomach was rotated and herniated into the esophageal hiatus. c The omentum (arrow) was adhered to the esophageal hiatus. d A 4 x 3 cm hiatal hernia was opened. e The crura were closed by a primary suture. f The anterior stomach wall was fixed in three places to the abdominal wall from the upper corpus to the antrum.
crg-0008-0032-g03.jpg
PMC3934612_01_crg-0008-0032-g03.jpg
F3
Using a laparoscope, we observed that the anterior stomach wall was adhered to the abdominal wall in three places from the antrum to the lower corpus of the stomach (fig. 3a). The upper corpus of the stomach was rotated and herniated into the esophageal hiatus (fig. 3b). However, it quickly returned into the esophageal hiatus with rotation because of the adhesion between the omentum and the esophageal hiatus (fig. 3c). This adhesion was peeled off and the crura were closed by a primary suture (fig. 3d, e). The cardial part of the stomach wall was fixed to the crura, and the anterior stomach wall was fixed in three places to the abdominal wall widely from the upper corpus to the antrum (fig. 3f).