[Endoscopic repositioning of the upside-down stomach and its fixation by percutaneous endoscopic gastrostomy].

HISTORY: A 77-year-old woman developed progressively increasing weakness, vertigo, dyspnoea, cardiac arrhythmias, left-sided chest pain, dyspepsia, dysphagia and weight loss. 11 years before admission she had a right mastectomy and 5 years later a left mastectomy, both for carcinoma.

FINDINGS: She had an iron deficiency anaemia (haemoglobin 6.8 g/dl, ferritin level 9 mg/dl, mean corpuscular volume 64.3 fl). Neoplasm was excluded by extensive radiological and endoscopic examination, which however demonstrated upside-down stomach due to a large paraesophageal hernia.

TREATMENT AND COURSE: Percutaneous gastroscopic gastrostomy was performed to reposition and fixate the stomach. Using two gastroscopes the stomach was replaced into the abdomen and fixed with three gastrostomies. The gastrostomy tubes were removed 15 days later. One year after the operation the patient was symptom-free and the stomach remained well fixed. A small residual hernia was still demonstrable radiologically.

CONCLUSION

This case suggests that percutaneous endoscopic gastrostomy is a satisfactory procedure for the repair of an upside-down stomach.