Vólvulo gástrico mesenteroaxial: Una rara complicación de la funduplicatura de Toupet

Introduction. Gastric volvulus is a rare and potentially life-threatening surgical emergency caused by the abnormal rotation of the stomach along its axes. It can be classified based on the type of rotation—organoaxial, mesenteroaxial, or mixed—and based on etiology—primary or secondary. Most secondary cases are associated with adhesions, diaphragmatic hernias, or prior upper gastrointestinal tract surgeries, such as fundoplications. Clinical case. A 68-year-old man presented with acute abdominal pain, coffee-ground emesis, melena, and signs of gastric outlet obstruction. He had undergone a Toupet fundoplication four months earlier. Imaging revealed pneumoperitoneum, severe gastric distension, and gastric wall pneumatosis, findings consistent with mesenteroaxial gastric volvulus. Laparoscopic exploration confirmed the diagnosis, revealing dense adhesions and subdiaphragmatic compression of the pylorus. Results. Surgical management included adhesiolysis, reduction of the volvulus, gastropexy, and a Stamm gastrostomy. The patient made a favorable recovery, with complete resolution of symptoms and adequate tolerance of a solid diet during postoperative follow-up. Conclusions. Mesenteroaxial gastric volvulus is an uncommon complication of Toupet fundoplication. This case highlights the importance of maintaining a high index of suspicion regarding obstructive symptoms in patients with a history of gastrointestinal surgery. Timely laparoscopic intervention allowed for reduction of the volvulus, preservation of gastric integrity, and prevention of recurrence, underscoring the value of early diagnosis and appropriate surgical management.