Acute tension gastrothorax post hiatal hernia repair and Nissen fundoplication: A case report

doi:10.12998/wjcc.121141

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World Journal of Clinical Cases

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2307-8960

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Report

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Cases. Aug 6, 2026; 14(22): 121141
Published online Aug 6, 2026. doi: 10.12998/wjcc.121141

Acute tension gastrothorax post hiatal hernia repair and Nissen fundoplication: A case report

Gonzalo Hagerman-Sucar, Diego A Vázquez-Nicolás, Verónica Quiñones-Corona, Montserrat Olaya-Herrera, Abel Rodríguez Reyes, Janette Furuzawa-Carballeda, Diana Aguilar-León, Gonzalo Torres-Villalobos

Gonzalo Hagerman-Sucar, Diego A Vázquez-Nicolás, Verónica Quiñones-Corona, Montserrat Olaya-Herrera, Janette Furuzawa-Carballeda, Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, CDMX, Mexico

Gonzalo Hagerman-Sucar, Janette Furuzawa-Carballeda, School of Medicine, Universidad Panamericana, Mexico 03920, CDMX, Mexico

Abel Rodríguez Reyes, General Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, CDMX, Mexico

Diana Aguilar-León, Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, CDMX, Mexico

Gonzalo Torres-Villalobos, Department of Experimental Surgery and Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico 14080, CDMX, Mexico

Co-first authors: Gonzalo Hagerman-Sucar and Diego A Vázquez-Nicolás.

Co-corresponding authors: Janette Furuzawa-Carballeda and Gonzalo Torres-Villalobos.

Author contributions: Hagerman-Sucar G, Vázquez-Nicolás DA, Quiñones-Corona V, Olaya-Herrera M, Furuzawa-Carballeda J, Aguilar-León D, Torres-Villalobos G, and Rodríguez Reyes A contributed to study conceptualization and design, manuscript review for important intellectual content; Hagerman-Sucar G, Vázquez-Nicolás DA, Quiñones-Corona V, and Olaya-Herrera M contributed to data acquisition, analysis, and interpretation; Hagerman-Sucar G, Vázquez-Nicolás DA, Quiñones-Corona V, Olaya-Herrera M, Rodríguez Reyes A, Furuzawa-Carballeda J, and Torres-Villalobos G contributed to manuscript drafting; Furuzawa-Carballeda J and Torres-Villalobos G supervised the project; Hagerman-Sucar G and Vázquez-Nicolás DA contributed equally to conceptualization and design of the study, data acquisition, analysis, interpretation, manuscript drafting, and critical review of the manuscript, warranting co-first author designation; Furuzawa-Carballeda J and Torres-Villalobos G contributed equally to conceptualization and design of the study, manuscript drafting, and critical review of the manuscript, and supervised the project, warranting co-corresponding author designation; all authors reviewed the final version to be published and agreed to be accountable for all aspects of the work.

AI contribution statement: The AI resource used for grammar and language polishing is ChatGPT 5.5. Each part of the main text (abstract, introduction, materials and methods, results, discussion and conclusion) was not entirely generated by AI. AI (ChatGPT 5.5) was only used as a proofreading tool for language and grammar polishing. AI did not participate in the design or interpretation of the research results. All the images presented in the manuscript were not generated by artificial intelligence.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Gonzalo Torres-Villalobos, MD, PhD, Professor, Department of Experimental Surgery and Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Vasco de Quiroga No. 15, Col Belisario Domínguez, Mexico 14080, CDMX, Mexico. torresvgm@yahoo.com.mx

Received: March 17, 2026
Revised: April 19, 2026
Accepted: June 24, 2026
Published online: August 6, 2026
Processing time: 139 Days and 18.8 Hours

Abstract

BACKGROUND

Acute intrathoracic gastric volvulus with tension gastrothorax is a rare, life-threatening condition. Predisposing factors include hiatal or diaphragmatic defects, prior hiatal surgery, and disorders associated with repetitive retching. This case highlights key risk factors and the characteristic clinical and radiologic features required for rapid recognition of this surgical emergency, while demonstrating the role of a staged surgical approach with second-look laparoscopy in optimizing gastric preservation.

CASE SUMMARY

A 64-year-old woman with a history of hiatal hernia repair and bulimia presented with 5 days of infectious gastroenteritis, persistent retching, epigastric pain, and progressive abdominal distension. Imaging revealed a left paraesophageal hernia with intrathoracic migration of the stomach and proximal duodenum, consistent with acute mesenteroaxial gastric volvulus complicated by tension gastrothorax. Initial nasogastric decompression was unsuccessful, prompting emergent laparoscopic exploration. The stomach was reduced and noted to have diffuse ischemia and a large intramural hematoma. Given uncertain viability, a staged approach was pursued. After intensive care stabilization, second-look laparoscopy on postoperative day 3 demonstrated complete restoration of gastric perfusion. Definitive hiatal repair and gastropexy were then performed. The patient was discharged in good condition and remained asymptomatic at 1- and 3-month follow-ups.

CONCLUSION

A staged surgical approach with second-look laparoscopy may facilitate gastric salvage in complex cases of intrathoracic gastric volvulus.

Keywords: Hiatal hernia; Gastric volvulus; Tension gastrothorax; Second-look laparoscopy; Risk factors; Case Report

Core Tip: Acute intrathoracic gastric volvulus with tension gastrothorax is a rare, life-threatening complication that can occur after hiatal hernia repair, particularly in the setting of repetitive retching. High index of suspicion is essential, as this condition represents a true surgical emergency and may present with clinical features indistinguishable from acute tension pneumothorax. Prompt surgical intervention is the cornerstone of management. Following gastric reduction, assessment of gastric viability remains the most challenging step. When viability is uncertain, a staged laparoscopic strategy with intensive care stabilization and planned second-look exploration permits reassessment of perfusion, helps avoid unnecessary gastrectomy, and supports successful gastric preservation.