A CASE OF MASSIVE INCARCERATED PARAESOPHAGEAL HERNIA (TYPE III) WITH GASTRIC VOLVULUS SUCCESSFULLY REPAIRED BY LAPAROSCOPIC NISSEN FUNDOPLICATION

We present a rare case of massive incarcerated type III paraesophageal hernia with gastric volvulus which has been successfully treated by laparoscopic surgery. An 84-year-old woman was admitted to the hospital because of hematemesis. Oozing from lacerated mucosa at the esophagogastric junction was detected by an emergency esophagogastrofiberscopy. Esophagogastrogram revealed entirely incarcerated organoaxial volvulus of the stomach. It was judged from findings of an endoscopy that blood supply to the stomach was not compromised. So an operation was performed after the general condition of the patient improved with total parenteral nuturition for three weeks. The operative procedures involved reduction of the hernia, mobilization of the esophagogastric junction, crural repair and floppy Nissen fundoplication with anchoring sutures. At the 8th-month follow-up, the patient is asymptomatic and has had no evidence of recurrence.