[Acute gastric volvulus: late complication of Nissen fundoplication. Report of two cases and review of the literature]

BACKGROUND

Gastric volvulus can be classified according to etiology as primary or secondary, according to anatomy as or mesenteroaxial, and according to onset as acute or chronic. Management of secondary gastric volvulus acute should always be surgery and the choice of surgical procedure for treatment is chosen according to etiology. Adherolysis and extraction of foreign bodies (suture, mesh, and gastric band) are important in those cases associated with previous abdominal surgery. Nissen fundoplication is a safe and effective procedure. Severe late complications of laparoscopic Nissen fundoplication are extremely rare occurrences. Among the reported complications is gastric volvulus.

OBJECTIVE

Presentation of two cases and review of literature.

CLINICAL CASES

Two cases of acute gastric volvulus secondary to laparoscopic Nissen fundoplication presenting with epigastric pain and nonproductive retching and treated by laparoscopy are described. Symptoms upon presentation, incidence, diagnosis, treatment and predisposing factors to gastric volvulus postfundoplication are discussed.

CONCLUSION

Gastric volvulus rarely occurs as a complication of Nissen fundoplication with an incidence similar to others of late complications. The described mechanisms that originate gastric volvulus postfundoplication are related to adhesions, foreign bodies as suture (polyester), gastrostomy tubes and mesh, gastropexy and internal gastric herniation through a "transfundoplication" window. A high index of suspicion is required in those patients presenting with acute symptoms of gastric obstruction in the first year following laparoscopic Nissen fundoplication. Laparoscopic approach is safe with or without gastropexy, always correcting the underlying mechanisms that cause gastric volvulus.

[Colonic necrosis and stricture due to non-occlusive ischemic colitis. Report of two cases and review of the literature]

BACKGROUND

Non-occlusive ischemic colitis appears to be a collection of diseases rather than a single entity. The presumed etiologies are numerous; however, it typically develops spontaneously in the absence of major vasculature occlusion. It includes a wide clinical spectrum ranging from mild to severe forms. Some patients may develop complications and management of this disorder depends on disease severity.

OBJECTIVE

Report of two cases and review of the literature.

CLINICAL CASE

Two cases are described, both requiring surgery with primary anastomosis. One patient had colonic gangrene that required an open right colectomy and the other a totally laparoscopic left colectomy for a stricture.

CONCLUSION

Non-occlusive ischemic colitis is idiopathic. Some patients requiring surgery may be selected to undergo primary anastomosis and laparoscopic surgery.