Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach

Figure 1 A chest X-ray film at admission, revealing air in the dilated stomach associated with air-fluid level (arrows), which was dislocated into the chest.

Figure 2 An upper gastrointestinal series performed preoperatively, revealing dislocated distal portion of the stomach (A) and duodenum (D) into the thoracic cavity rotated in the mesenteric axis, which corresponded to a mesenterioaxial volvulus of the upper gastrointestinal tract.

Figure 3 Abdominal computed tomography scan. An incarcerated upper gastrointestinal tract in the thoracic cavity (arrows). The gastrointestinal tract dislocated in the thoracic cavity was significantly dilated, where fluid had accumulated.

Figure 4 Laparoscopic view after initial reduction of the stomach from the chest into the abdomen. Sliding hernia and parahiatal hernia. A: A paraesophageal aperture (arrows) was large-sized and was located at the left side of the left crus of the esophageal hiatus; B: Hernia orifice was closed using the mesh reinforcement.

Figure 5 A postoperative upper gastrointestinal series performed at 5 d after surgery, showing the normal intraperitoneal location of the stomach and duodenum.