Mesenteroaxial gastric volvulus in an elderly patient 5 years after Nissen fundoplication and hiatal hernia repair

Gastric volvulus is a rare and potentially life-threatening condition that usually presents acutely and requires immediate intervention via either endoscopic or surgical detorsion. Most often, it presents secondary to a hiatal hernia, with herniation and torsion of the stomach through the hiatus. Only a small subset of patients present with gastric volvulus after Nissen fundoplication for hiatal hernia repair. We report the case of an elderly patient with a previous hiatal hernia repair with Nissen fundoplication who presented with an intra-abdominal gastric volvulus that developed over the course of several months. The combination of her surgical history and volvulus etiology made her disease rare. She was treated with laparoscopic surgery and gastropexy with gastrostomy tube placement, which led to the resolution of the upper gastrointestinal symptoms.