Gastric volvulus following Nissen fundoplication: a case report and review of reported cases, risk factors, and management strategies

Gastric volvulus is a rare but potentially life-threatening complication following Nissen fundoplication, with delayed diagnosis increasing the risk of gastric ischemia, necrosis, and perforation. We report the case of a 72-year-old man who presented on postoperative Day 10 with progressive dysphagia, severe epigastric pain, and intolerance to oral intake following robot-assisted laparoscopic Nissen fundoplication. Computed tomography and upper gastrointestinal contrast study demonstrated marked gastric distension with obstruction at the gastroesophageal junction. Urgent diagnostic laparoscopy revealed a complete retroesophageal organoaxial gastric volvulus around an intact fundoplication wrap. The patient subsequently underwent robot-assisted gastric decompression, reduction of the volvulus, takedown of the fundoplication, and posterior gastropexy. Postoperative recovery was uneventful. This case highlights the importance of maintaining a high index of suspicion for gastric volvulus in patients with persistent obstructive symptoms after fundoplication and demonstrates that prompt minimally invasive surgical intervention can prevent catastrophic complications.