Souad Ghattas*, Hani Maalouf, Ribal Aby Hadeer, Fawzi Elias, Hadi Khaled Abou Zeid, Anthony Kahy and Raja Wakim
Gastric volvulus in conjunction with diaphragmatic hernia is an uncommon but life-threatening presentation that is usually associated with congenital para-esophageal hernia and traumatic diaphragm injury. However, it has been rarely described with cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC). We herein report the case of a 68-year-old woman presenting with signs and symptoms of acute upper gastro-intestinal (GI) obstruction with back and chest pain, 3 years after debulking surgery and HIPEC for peritoneal carcinomatosis secondary to advanced ovarian cancer. A diagnosis of gastric volvulus was established based on gastroscopy, barium swallow, and computed tomography (CT) scan, and urgent laparotomy revealed a rotated stomach adherent to the spleen and left diaphragm. After reduction, a diaphragmatic defect that was missed on CT scan was discovered and repaired, and the patient recovered uneventfully. Diaphragmatic hernia with gastric volvulus can occur many years after cytoreductive surgery and HIPEC despite initial diaphragm intactness, and should be suspected in this patient population when they present with upper GI obstruction.
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