Paraesophageal Hernias with Perforation

Acute gastric volvulus presents with the classic triad of severe epigastric pain, vomiting, and difficulty or inability to pass a nasogastric tube. It can be complicated by strangulation and perforation which are associated with high mortality rates. Quick diagnosis and attempt at decompression is paramount. Computer-aided tomography is an important diagnostic step, and findings such as gastric wall thickening, extraluminal gas, and mediastinal fluid should prompt urgent surgical intervention. Approaches can include minimally invasive or open operations and in general should include reduction of the hernia, resection of devitalized tissue, and in some cases esophageal exclusion with delayed reconstruction.