Case Report
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World J Gastrointest Surg. Sep 27, 2014; 6(9): 183-186
Published online Sep 27, 2014. doi: 10.4240/wjgs.v6.i9.183
Gastric necrosis: A late complication of nissen fundoplication
Javier Salinas, Tihomir Georgiev, Juan Antonio González-Sánchez, Elena López-Ruiz, José Antonio Rodríguez-Montes
Javier Salinas, Tihomir Georgiev, Juan Antonio González-Sánchez, José Antonio Rodríguez-Montes, Department of General Surgery, Hospital Universitario La Paz, Madrid 28046, Spain
Elena López-Ruiz, Department of Pathology, Hospital Universitario La Paz, Madrid 28046, Spain
Author contributions: Salinas J, Georgiev T and González-Sánchez JA performed the surgery; López-Ruiz E performed the anatomopathological examination; Salinas J reviewed current literature and wrote the paper; González-Sánchez JA and Rodríguez-Montes JA coordinated the paper elaboration and revised the article.
Correspondence to: Javier Salinas, MD, Department of General Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain. jsalinas@icomen.es
Telephone: +34-91-2071667 Fax: +34-91-2071064
Received: April 8, 2014
Revised: July 4, 2014
Accepted: July 17, 2014
Published online: September 27, 2014
Processing time: 174 Days and 5.7 Hours
Abstract

Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. “Gas-bloat” syndrome is a well known Nissen fundoplication postoperative complication. It may cause severe gastric dilatation, but very rarely an ischemic compromise of the organ. Other factors, such as gastric outlet obstruction, may concur to cause an intraluminal pressure enough to blockade venous return and ultimately arterial blood supply and oxygen deliver, leading to ischaemia. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and a pyloric phytobezoar which was the trigger event. No preexisting gastric motility disorders were present by the time of surgery, as demonstrated in the preoperative barium swallow, thus a poor mastication (patient needed no dentures) of a high fiber meal (cabbage) may have been predisposing factors for the development of a bezoar in an otherwise healthy women at the onset of old age. A total gastrectomy with esophagojejunostomy was performed and patient was discharged home after a 7-d hospital stay with no immediate complications. We also discuss some technical aspects of the procedure that might be important to reduce the incidence of this complication.

Keywords: Gastric dilatation; Gastric outlet obstruction; Necrosis; Fundoplication; Nissen operation

Core tip: Gastric necrosis is a rare condition because of the rich blood supply and the extensive submucosal vascular network of the stomach. “Gas-bloat” syndrome is a Nissen fundoplication postoperative complication that causes gastric dilatation, but very rarely an ischemic compromise of the organ. We report a case of a 63-year-old women, who presented a total gastric necrosis following laparoscopic Nissen fundoplication and we discuss technical aspects of the procedure that are important to prevent this complication.