Two Hernias, One Patient: A Case of Organoaxial Gastric Volvulus in a Paraesophageal Hernia With an Incisional Hernia.

A 65-year-old male presented with abdominal pain and swelling persisting for five years. On clinical examination, a 15 cm transverse scar was noted above the umbilicus, along with a reducible incisional hernia. Contrast-enhanced CT of the abdomen revealed an incisional hernia with a single defect at the umbilical and epigastric regions with European Hernia Society classification of M2-3, W3, along with a rolling-type paraesophageal hernia. He underwent surgical repair for the incisional hernia by hybrid procedure. One month post-discharge, he developed progressive nausea, vomiting, and food intolerance. Repeat imaging and upper GI endoscopy suggested a large hiatal hernia with organoaxial gastric volvulus. Laparoscopic derotation with cruroplasty and Toupet fundoplication was performed with a successful outcome. This case illustrates a rare dual presentation of two distinct hernias, underscoring the need for comprehensive preoperative evaluation and discussing the possible factor of raised intra-abdominal pressure that can lead to gastric volvulus.