INTRODUCTION: An incarcerated paraesophageal hernia with organoaxial volvulus is associated with high morbidity and complications if not promptly repaired.

METHODS: This is 49 year old female with a medical history of cerebral vascular accident, gastroesophageal reflux disease, hypertension, hypothyroidism, prior cholecystectomy and a known history of a hiatal hernia. She was originally scheduled for repair but delayed due to scheduling. She presented to an outside facility with abdominal pain, hematemesis and leukocytosis. A CT of A/P were obtained which revealed a large paraesophageal hernia with evidence of an organoaxial gastric volvulus and severe distention of the stomach concerning for a gastric outlet obstruction. An upper gastrointestinal study (UGIS) revealed similar findings. After she was resuscitated and a nasogastric tube was placed, she was urgently taken to the operating room for a laparoscopic hiatal hernia repair with mesh and nissen fundoplication.

RESULTS: The operation was completed as planned without intraoperative complications. Operative time took 4.0 hours. Blood loss was minimal. On postoperative day 1, she had an UGIS which was negative for leak and restoration of normal anatomy. She was subsequently started on clears and discharged later that day.

CONCLUSION: We demonstrate a laparoscopic repair of a paraesophageal hernia complicated by an organoaxial gastric volvulus in the acute setting is feasible.