Complex Hiatal Hernia with Gastric Volvulus Successfully Managed by Hiatal Plasty and Nissen Fundoplication: A Case Report

Background: Hiatal hernias, particularly those complicated by gastric volvulus, represent a rare but potentially life-threatening condition. Prompt diagnosis and surgical intervention are crucial to prevent severe complications such as strangulation and ischemia of the stomach. This case report details the presentation, diagnosis, and successful surgical management of a Type IV hiatal hernia with an associated gastric volvulus using hiatal plasty and Nissen fundoplication. Case Presentation: We present the case of a 65-year-old male with a history of recurrent epigastric pain, nausea, and postprandial vomiting, who was diagnosed with a Type IV hiatal hernia complicated by an organoaxial gastric volvulus. Imaging studies confirmed the diagnosis, revealing significant herniation of the stomach into the thoracic cavity. The patient underwent elective surgical repair involving a hiatal plasty to restore the diaphragmatic hiatus, followed by a Nissen fundoplication to prevent recurrence. Postoperative recovery was uneventful, with resolution of symptoms and no recurrence at a six-month follow-up. Conclusion: This case underscores the importance of timely recognition and appropriate surgical management of hiatal hernias complicated by gastric volvulus. The combined approach of hiatal plasty and Nissen fundoplication provides effective relief and prevents recurrence, contributing to favorable long-term outcomes.