Rare case of upside-down stomach in advanced hiatal hernia

Nooraldin Merza MD, John Lung BS, Omar Bazzaz MD, Farah Aljuboory MD, Mazin Saadaldin MD, FRCS


Upside-down stomach (UDS) is the rarest type of hiatal hernia; it involves migration of the entire stomach into the posterior mediastinum with volvulus. We report a patient with chronic gastroesophageal reflux disease (GERD) and myelodysplastic syndrome who was admitted for syncope and signs of aspiration pneumonia with an incidental findings of hiatal hernia type IV with UDS. The patient had been experiencing generalized weakness and had a history of multiple falls without head injury. He was not in acute distress. The chest x-ray was suspicious for pneumonia. The patient had a hemoglobin level of 6.8 g/dl and was transfused with multiple units of packed erythrocytes during his hospitalization for treatment of his anemia secondary to myelodysplastic syndrome. Computed tomography of the thorax revealed a large hiatal hernia type IV with UDS in the posterior mediastinum. Surgical intervention was recommended, but the patient elected to postpone surgery due to the lack of symptoms. He died one month later from complications related to myelodysplastic syndrome. The diagnosis of upside-down stomach can be suspected on chest x-ray but requires a high degree of suspicion. All surgical interventions for UDS must consider the overall prognosis of the patient and estimated improved quality of life before repair, especially given the high recurrence rate of UDS after surgical repair.

Keywords: Upside-down stomach, hiatal hernia, paraesophageal hernia, gastric incarceration, gastric outlet obstruction, gastric volvulus

Article citation: Merza N, Lung J, Bazzaz O, Aljuboory F, Saadaldin M. Rare case of upside-down stomach in advanced hiatal hernia. The Southwest Respiratory and Critical Care Chronicles 2019;7(31):52–55
From: Department of Internal Medicine (NM, MS) and School of Medicine (JL) Texas Tech University Health Sciences Center, Amarillo, Texas; Department of Internal Medicine (OB), Veterans Affairs Medical Center, Amarillo, Texas; BSA Health System (FA), Amarillo, Texas
Submitted: 9/22/2019
Accepted: 10/7/2019
Reviewer: Kenneth Nugent MD
Conflicts of interest: none
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