외상성 횡경막 탈장에 합병된 만성 위염전

A clinical review was made on a case of chronic gastric volvulus with previous traumatic diaphragmatic hernia which was operated upon the Department of Gener al Surgery, Soon Chun Hyang University Hospital, Chun An, Korea, on March, 1994. Gastric volvulus is a rare disease defined as torsion of the stomach of more than 180 with closed loop obstruction, which usually combined with idiopathic or secondary diaphragmatic hernia, eventration of diaphragm, hiatal hernia. Gastric volvulus may occur at any age, especially fifth decade and the incidence is approximately the same in both sexes. Acute volvulus presents a striking clinical picture first described in 1904 by Bor chardt, who emphasized the following three features. 1. Severe epigastric pain and distension. 2. Vomiting followed by violent retching with an inability to vomit. 3. Difficulty or inability to pass a nasogastric tube. Chronic volvulus may be symptomless and an incidental finding on a barium enema or chest x-ray film. When symptoms occur, they are frequently those of mild, continuous or intermittent upper abdominal discomfort that may be impossiblc to differentiate from peptic ulcer, calculous disease of gallbladder. Most cases of total gastric volvulus are organoaxial, as are the majority of acute case and this type is usually associated with diaphragmatic hernia of eventration. In contrast, the mesenteroaxial type is more often idiopathic and partial in extent chronic volvulus. Acutc volvulus can sometimes be reduced by the passage of nasogastric tube but in most cases it cannot be passed, and immediate operation will be required. If primary volvulus has no obvious cause, gastropexy must be considered by taking the anterior wall of the stornach to the parietal peritoneum. If gastric necrosis has taken place, local excision, subtotal gastrectomy or total gastrectomy will be required, depending on the extent of' the ischemic injury. A case of chronic, organoaxial and mesenteroaxial gastric volvulus complicated traumatic diaphragmatic hernia was treated surgically by primary repair of diaphragmatic clefect and gastropexy, and the patient was good prognosis postoperatively. The authors report with a review of literatures.