Management of Acute Upside-down Stomach

Tobias S Schiergens; Michael N Thomas; Thomas P Hüttl; Wolfgang E Thasler


BMC Surg. 2013;13(55) 

In This Article


We present an exceptionally challenging case of a young patient with a history of Ebstein's anomaly and a giant recurrent hiatal hernia becoming clinically manifest in an incarcerated UDS. In spite of anterior hemifundoplication two years ago the patient presented with this clinically and patho-anatomically impressive recrudescence. A genetically related common cause for cardiac and hiatal tissue defect can be hypothesized but was not assessed for lack of therapeutic consequences in this patient. However, given the fact of a recurring and very large hernia in spite of previous surgical repair as well as the postulated underlying tissue deficiency, we decided in favor of insertion of an absorbable mesh for hiatal reinforcement and tension-free repair. However, in the view of the above described complications associated with mesh implantation, we are exceedingly reserved regarding routine use of meshes and recommend thorough indication.


Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.