Title : The rare case of concurrent caecal volvulus and type IV hiatal hernia presenting simultaneously at distinct anatomical sites, laparoscopy turned into laparotomy
Abstract:
This case report demonstrates the rare case of concurrent caecal volvulus and type IV hiatal hernia presenting simultaneously at distinct anatomical sites. Type IV hiatal hernias, or paraesophageal hernias, are complex and rare conditions, comprising 2-5% of the 5% of all hernias. They result from a defect in the phrenoesophageal membrane, allowing for the protrusion of the stomach and abdominal contents. Caecal volvulus, characterized by the twisting of the caecum around its mesentery, is another rare condition, accounting for less than 1% of bowel obstructions. While both conditions can involve volvulus of the colon within the hernia sac, this case report describes an unusual presentation of caecal volvulus occurring simultaneously with a Type IV hiatal hernia, without the volvulus protruding through the hernia sac. A 71-year-old woman with a known history of hiatal hernia presented with acute right abdominal pain exacerbated by coughing. Physical examination revealed an abdominal mass in the right lower quadrant, prompting the insertion of a Ryles tube for bowel decompression. A CT scan indicated incomplete obstruction due to a large hiatal hernia containing the stomach and transverse colon, with the small bowel remaining undilated. The patient underwent emergency laparoscopic repair of the Type IV hiatal hernia, involving mesh placement, Nissen fundoplication, and gastropexy. During the procedure, it was noted that the caecum remained distended despite the release of the transverse colon. Upon further exploration via mini laparotomy, multiple serosal tears and evidence of caecal volvulus were identified. A right hemi-colectomy was performed, followed by ileo-colic anastomosis. This case highlights the diagnostic and management challenges associated with concurrent gastrointestinal conditions, underscoring the importance of thorough evaluation and intervention in rare presentations.
