Total gastrectomy for acute organoaxial gastric volvulus

A 74-year-old woman was referred to our hospital for acute upper abdominal fullness and pain. Computed tomography showed a part of the stomach had migrated into the left thoracic cavity and significant dilatation of the stomach in the left thoracic cavity and abdominal cavity. We attempted to insert a nasogastric tube but failed. Under a diagnosis of esophageal hiatus hernia in which the stomach was incarcerated, an emergency operation was performed because she went into shock. On laparotomy, we found herniation of the upper stomach through an esophageal hiatus. An organoaxial gastric volvulus of the stomach and massive necrosis of the gastric wall were confirmed, so we decided to perform total gastrectomy. Postoperatively she had minor dehiscence of the esophagojejunostomy, but she recovered by conservative therapy. Gastric volvulus is relatively rare in adults and frequently presents in chronic or recurrent form. Although in the case of acute gastric volvulus with diaphragmatic hernia, urgent surgery is often performed, reduction is usually easy. However, necrosis in most of the stomach is very unusual. We report an unusual case of an acute gastric volvulus, resulting massive gastric wall necrosis, which was treated with total gastrectomy.