Perforated Cameron's Ulcer from Incarcerated Paraesophageal Hernia with Gastric Volvulus.

BACKGROUND

Cameron ulcers are linear erosions or ulcerations in the setting of large hiatal hernias with potential to lead to life-threatening complications. We report a rare complication of a Cameron ulcer in the setting of an incarcerated paraesophageal hernia with gastric volvulus.

CASE DESCRIPTION: An 84 year old female presented in shock from gastric perforation. Imaging demonstrated significant pneumoperitoneum, free fluid, and a large incarcerated paraesophageal hiatal hernia with gastric volvulus. The patient underwent diagnostic laparoscopy revealing a perforated Cameron ulcer with subsequent laparoscopic reduction of incarcerated parasesophageal hiatal hernia, repair of Cameron ulcer perforation, and abdominal washout. Postoperative course was complicated by multiple intra-abdominal collections, mediastinitis, venous thromboses, choledocholithiasis, and persistent leak from gastric perforation, ultimately transitioning her care to comfort measures only.

DISCUSSION: This case highlights a rare but severe manifestation of Cameron ulcers and underscores the importance of early recognition of complications associated with large paraesophageal hernias.