Thursday, July 15, 2010
This elderly guy presented with acute renal failure due to vomiting everything he tried to eat or drink for a week. He was rehydrated and decompressed. The images above demonstrate a complete foregut obstruction secondary to herniation and volvulus of the stomach through a large hiatal hernia. On the coronal view, you can actually see the pylorus and dilated 1st part of duodenum in the thorax.
I reduced his elephantine stomach and repaired the crural defect. I also did a pyloroplasty and affixed his fundus to the abdominal wall with a gastropexy. He was eating lukewarm hospital chicken casserole by day three. Fun case.