Kim Hyung Hun, Park Seun Ja, Park Moo In, Moon Won
Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Case Rep Gastroenterol. 2011 May;5(2):272-7. doi: 10.1159/000328444. Epub 2011 May 6.
Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia. Iatrogenic diaphragmatic hernia can occur after hiatal hernia repair and other surgical procedures, such as nephrectomy, esophagogastrectomy and splenopancreatectomy. We describe a 49-year-old woman who presented to our emergency department with acute moderate epigastric soreness and vomiting. She had undergone extensive gynecologic surgery including splenectomy 1 year before. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field. An urgent gastroscopy showed twisted structural abnormality of the stomach body. A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating.
急性胸内胃扭转是指由于裂孔扩大或膈疝导致胃在胸腔内发生器官轴扭转。医源性膈疝可发生于食管裂孔疝修补术及其他外科手术之后，如肾切除术、食管胃切除术和脾胰切除术。我们报道一名49岁女性，因急性中度上腹部酸痛和呕吐就诊于我院急诊科。她在1年前接受了包括脾切除术在内的广泛妇科手术。急诊科拍摄的胸部X线片显示左下肺野胃内气液平面升高。紧急胃镜检查显示胃体扭曲的结构异常。计算机断层扫描显示扩张的胃通过左侧膈肌缺损位于左下胸腔。遂行急诊经胸修补术。术后恢复顺利，患者未出现任何疼痛或进食困难。
