Intrathoracic stomach ischemia successfully treated with gastric imbrication – a case report and literature review

BACKGROUND: The management of large paraesophageal hiatal hernias (PEH) is challenging as most patients are elderly with multiple comorbidities. Furthermore, compared to elective procedures, emergency interventions are often associated with even greater complexity. Laparoscopic PEH repair is generally considered safe and feasible, even in urgent cases; however, complications such as acute incarceration and its progression to stomach wall necrosis, which usually requires resection, carries a high risk of morbidity and mortality. METHODS: We present a case of acute PEH incarceration with gastric ischemia. Additionally, we conducted a narrative literature review to examine cases of gastric ischemia secondary to acute hiatal hernia strangulation. RESULTS: A 71-year-old man presented with abdominal pain, nausea, and retching. Computed tomography on admission revealed an intrathoracic stomach without signs of complication, while endoscopy showed an ischemic fundus. The patient underwent laparoscopic hiatal hernia repair and gastric imbrication of the ischemic area. At the three-month follow-up, the patient reported no complaints. Twenty-two fully described cases in the literature were retrieved. CONCLUSION: To the best of our knowledge, this is the first reported case of a patient successfully treated with laparoscopic reduction of a hiatal hernia followed by imbrication of the ischemic area. The procedure resulted in a favorable outcome without the need for resection and reconstruction. Moreover, our literature review represents the first effort to collect data on this rare and complex condition, providing further insight into its presentation and management.