Acute gastric volvulus secondary to paraesophageal hiatal hernia can be a life-threatening condition, causing gastric necrosis, perforation and sepsis. Emergency surgery with total or partial proximal gastrectomy, obligates the patient to a second challenging procedure to re-establish gastrointestinal continuity.
Laparoscopic esophagojejunostomy is a technically demanding procedure; this is especially true when the procedure is the second stage for reconstruction following an emergency total gastrectomy for gastric necrosis and perforation.
We present two cases of paraesophageal hiatal hernia, with intrathoracic, upside-down stomach and extensive gastric necrosis. Both patients were successfully treated with gastrectomy (one total and the other proximal subtotal), distal esophageal stapling, placement of a feeding jejonostomy and endoscopic, ultrasound-guided cervical esophagostomy.
Gastrointestinal continuity was reconstituted a few months later, with laparoscopic esophagojejunostomy.
For the laparoscopic reconstruction, the mean estimated blood loss was 1075 ml, the mean operation time was ten hours and 49 minutes, and mean length of stay was nine and half days.
* Case 1 suffered from coronary artery disease and was on Aspirin and Plavix.
We present these two cases with the technical details of the procedure and a review of the literature.
Program Number: P357