Intrathoracic gastric torsion following surgical management of a type IV hiatal hernia

A five-month-old French bulldog was referred for assessment and management of regurgitation. Investigations suggested a type IV hiatal hernia, with the stomach and spleen found to be within the thorax. This was surgically managed with a phrenoplasty and fundic gastropexy. The dog recovered well and was free from clinical signs for four months, at which point he presented with sudden onset tachypnoea and increased respiratory effort. Radiographs identified a distended stomach within the thorax. An emergency coeliotomy identified that the stomach had torsed 180° around the gastropexy and herniated, along with the spleen, through the oesophageal hiatus. A sternotomy was required to decompress and subsequently reduce the stomach and spleen into the abdomen. The gastric torsion was corrected, and a right-sided gastropexy, a phrenoplasty and oesophagopexy were performed. The dog was doing well with no evidence of regurgitation four months following surgery.