Congenital Right Intrathoracic Stomach Secondary to Hiatus Hernia in an Infant.

A four month old, female infant presented with acute onset respiratory distress and persistent, non-bilious vomiting for one day. The initial chest radiograph showed two large, fluid filled structures in the right hemi thorax. An upper GI contrast study showed right intrathoracic stomach with hold-up of barium in the pylorus. A diagnosis of congenital right intra-thoracic stomach with organo-axial torsion was made and patient underwent laparotomy and repair of the hiatal defect. The child is asymptomatic on follow up. The case is reported for unusual symptomatic presentation on early infancy.

Laparoscopic suture gastropexy for chronic gastric volvulus

Gastric volvulus is a rare condition, however it may result in serious complications. It occurs mainly as a result of congenital laxity of the stomach's attachments and might be accompanied by a diaphragmatic hernia. A patient may have acute or chronic disease. We present 6 patients of chronic gastric volvulus who were managed with laparoscopic suture gastropexy. We managed 6 patients with chronic gastric volvulus during the past 4 years. All of them had primary and organoaxial type of volvulus. All of them were proved by barium meal study and underwent elective surgery in the form of laparoscopic posterior suture gastropexy. All patients recovered well from surgery. The postoperative pain was minimal with early ambulation. The average hospital stay was 3 days. There was neither morbidity nor mortality. Follow up with barium meal studies gave good results in all cases. Diagnosis of chronic gastric volvulus needs a high index of suspicion. This is because of its rarity and its similarity with other more common diseases as cholelithiasis and peptic ulcer. Confirmation of diagnosis requires barium meal study. It could be managed either by open surgery, by laparoscopic/ endoscopic approach or by laparoscopic approach alone. Laparoscopic suture gastropexy gives good results. Eventhough worldwide experience in laparoscopic surgery for gastric volvulus is limited, the results are encouraging. Laparoscopic management seems to be safe and feasible