PMC3995379_01
a Upper esophagogastric series. The body of the stomach was located above the fundus, situated on the cephalic side, showing organoaxial rotation, and the entire stomach was located in the mediastinum, which indicated upside-down stomach. The gastric tumor (arrows) was found in the upper body of the stomach. b Coronal computed tomography images revealed that the entire stomach (arrows) was herniated into the mediastinum through the esophageal diaphragmatic hiatus.
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F1
PEH (fig. 1a). Pathological analysis of biopsy specimens revealed moderately differentiated tubular adenocarcinoma. Coronal computed tomography images showed an organoaxial gastric volvulus and sliding up through a PEH (fig. 1b).
Operative findings. a The entire stomach was found to be herniated through the enormously dilated hiatus into the left thorax together with the greater omentum. b The hernial orifice was found to be approximately 5 cm in diameter after the incarcerated stomach had been reduced back into the abdomen. c The crura of the diaphragm were closed and the jejunum just under the anastomosis was sutured to the crus to permanently fix the esophagojejunal anastomosis in an abdominal position.
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F2
The entire stomach was found to be herniated through the enormously dilated hiatus into the left thorax together with the greater omentum (fig. 2a). The hernial orifice was approximately 5 cm in diameter (fig. 2b). The jejunum just under the anastomosis was sutured to the crus to permanently fix the esophagojejunal anastomosis in an abdominal position (fig. 2c).
Macroscopic finding showed a type 1 large tumor at the small curvature in the middle and upper body of the stomach.
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F3
The resected specimen revealed a type 1 hemorrhagic tumor measuring approximately 7.7 x 7.4 cm (fig. 3).