Gastric Volvulus After Nissen Fundoplication: A Case Report

Gastric volvulus is a rare condition in which there is an abnormal rotation of the stomach, which can be life-threatening. Most cases occur in patients with a hiatal hernia or other diaphragmatic defects. Gastric volvulus after Nissen fundoplication has been rarely reported, with several proposed mechanisms. We present the case of a 53-year-old woman with a history of previous Nissen fundoplication who presented with nausea and vomiting due to a mesenteroaxial gastric volvulus caused by an adhesion. Adhesiolysis and volvulus reduction were performed, along with gastropexy. The postoperative course was complicated by septic shock due to bacterial translocation, requiring intensive care unit (ICU) admission. The patient subsequently recovered fully. Gastric volvulus may present acutely or with more intermittent symptoms. Diagnosis is often challenging, as Borchardt's triad is not always present. Endoscopy may be a valuable tool in diagnosis and initial management, but definitive treatment is surgical. In this case, the fundoplication remained intact with the volvulus being attributed to adhesions and gastric laxity. Despite prompt intervention and the absence of ischemia, the patient still developed septic shock and required ICU admission, underscoring the importance of early recognition and management. Gastric volvulus can occur after Nissen fundoplication even without hernia recurrence. Prompt diagnosis and intervention are crucial to avoid complications. In stable patients with a viable stomach, surgery should aim to restore anatomy and prevent recurrence.