Laparoscopic reduction of gastric volvulus and repair of giant hiatal hernia in a neonate

Intrathoracic gastric volvulus in the neonatal period is an extremely rare surgical problem that may present with acute respiratory decompensation or be discovered incidentally. Previously, only one report has described the laparoscopic evaluation and management of this problem in the newborn. The authors present the case of a 3-week-old term infant who presented with failure to thrive, tachypnea during feedings, and frequent emesis. Chest radiography revealed an intrathoracic stomach, which was confirmed on barium swallow and demonstrated no obstruction or gastroesophageal reflux. Laparoscopic gastric reduction, repair of a large hiatal hernia defect, and gastrostomy tube placement were performed. One week after the initial procedure, emesis recurred, and the infant was found to have hypertrophic pyloric stenosis, which was managed by laparoscopic pyloromyotomy. During the next few weeks, the infant initially fed well, but then severe gastroesophageal reflux developed, with failure to sustain adequate weight gain. At this point, a laparoscopic Nissen fundoplication was performed, which has allowed her to achieve full feedings and attain adequate nutrition and growth.