Paraesophageal Hernia and Gastric Volvulus

Abstract

The progression of hiatal hernias to complications of incarcerated paraesophageal hernias and acute gastric volvulus represents the extreme, life-threatening situations, in which acute care surgeons encounter patients with these conditions. Complications of paraesophageal hernias including gastric volvulus can present with the patient in extremis necessitating rapid fluid resuscitation, correction of metabolic and electrolyte derangements, nasogastric decompression, and the initiation of broad spectrum antibiotics. Urgent surgical intervention often includes the use of endoscopic, laparoscopic, and open techniques to achieve gastric reduction and derotation as well as resection of necrotic tissue in staged or “damage control” procedures where necessary.