Type III Paraesophageal Hernia with Gastric Volvulus Following Laparoscopic Fundoplication with Intrarectal Mesh Migration After Laparoscopic Mesh Rectopexy in The Same Patient

Int. Jr. of Contemp. Res. in Multi. PEER-REVIEWED JOURNAL Volume 4 Issue 5 [SepOct] Year 2025 331 © 2025 Dr. Manju Singh, Dr. Amit Agrawal, Dr. Abhijeet Bhattacharya, Dr. Pooja Jain. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY NC ND).https://creativecommons.org/licenses/by/4.0/ Case Report Type III Paraesophageal Hernia with Gastric Volvulus Following Laparoscopic Fundoplication with Intrarectal Mesh Migration After Laparoscopic Mesh Rectopexy in The Same Patient Dr. Manju Singh 1, Dr. Amit Agrawal 2, Dr. Abhijeet Bhattacharya 3, Dr. Pooja Jain 4* 1,2,3,4 Department of General Surgery, Pt. JNM Medical College, Raipur, Chhattisgarh, India Corresponding Author: *Dr. Pooja Jain DOI: https://doi.org/10.5281/zenodo.17341546 Abstract Manuscript Information Background: Complete rectal prolapse represents a full-thickness circumferential descent of the rectal wall through the anal orifice. Laparoscopic mesh rectopexy is an effective surgical technique, but mesh-related complications such as erosion, obstruction, and migration, though rare, can have serious consequences. Likewise, paraesophageal herniation with gastric volvulus is a recognized but uncommon complication following laparoscopic Nissen fundoplication. Case Presentation: A 30-year-old male presented with abdominal pain, vomiting, constipation, and incomplete evacuation. He had undergone laparoscopic mesh rectopexy 10 years prior and laparoscopic fundoplication for GERD one year earlier. Imaging revealed a type 3 paraesophageal hernia with organoaxial gastric volvulus and intrarectal mesh migration. The patient underwent open paraesophageal hernia repair with mesh hernioplasty and transanal mesh removal. Outcome: Postoperative recovery was uneventful, and the patient was discharged on the seventh day with complete symptom resolution. Discussion: Mesh migration following laparoscopic rectopexy, although rare, is a serious complication more commonly associated with synthetic meshes. Similarly, paraesophageal herniation and gastric volvulus may occur after fundoplication due to anatomical and procedural factors. Early recognition and prompt surgical management are essential for optimal outcomes. Conclusion: This case underscores the importance of long-term follow-up after mesh rectopexy and vigilance for delayed mesh migration. Additionally, clinicians should maintain high suspicion for paraesophageal hernia and gastric volvulus in postfundoplication patients presenting with upper gastrointestinal symptoms. ▪ ISSN No: 2583-7397 ▪ Received: 19-08-2025 ▪ Accepted: 27-09-2025 ▪ Published: 13-10-2025 ▪ IJCRM:4(5); 2025: 331-334 ▪ ©2025, All Rights Reserved ▪ Plagiarism Checked: Yes ▪ Peer Review Process: Yes How to Cite this Article Singh M, Agrawal A, Bhattacharya A, Jain P. Type III paraesophageal hernia with gastric volvulus following laparoscopic fundoplication with intrarectal mesh migration after laparoscopic mesh rectopexy in the same patient. Int J Contemp Res Multidiscip. 2025;4(5):331-334. Access this Article Online www.multiarticlesjournal.com KEYWORDS: Rectal prolapse, Mesh migration, Rectopexy, Paraesophageal hernia, Gastric volvulus, Fundoplication complications Int. Jr. of Contemp. Res. in Multi. PEER-REVIEWED JOURNAL Volume 4 Issue 5 [SepOct] Year 2025 332 © 2025 Dr. Manju Singh, Dr. Amit Agrawal, Dr. Abhijeet Bhattacharya, Dr. Pooja Jain. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY NC ND).https://creativecommons.org/licenses/by/4.0/ INTRODUCTION BACKGROUND Complete rectal prolapse is a circumferential full-thickness descent of the rectal wall through the anal orifice. Laparoscopic mesh rectopexy is a well-established surgical procedure with low morbidity and mortality. However, mesh-related complications such as erosion, bowel obstruction, and fecal impaction have been reported. Intrarectal mesh migration is a rare but significant complication. Laparoscopic Nissen fundoplication has led to an increased number of anti-reflux procedures. Among its complications, paraesophageal herniation with gastric volvulus is a severe condition that may progress to gangrene and perforation. In this case, the patient developed both mesh migration and type 3 paraesophageal hernia with gastric volvulus following separate surgical procedures. CASE PRESENTATION A 30-year-old male presented to the emergency department with abdominal pain and vomiting for 7 days. He reported constipation and incomplete evacuation for 20 days. His surgical history included a laparoscopic mesh rectopexy for rectal prolapse 10 years before, and a laparoscopic fundoplication for GERD with hiatus hernia one year prior. Despite surgery, he experienced persistent heartburn unrelieved by antacids. On examination: • Vitals: BP: 106/82 mmHg, Pulse: 103/min, SpO2: 96% on room air. • Respiratory System: Decreased breath sounds on the left side. • Abdomen: No remarkable findings. • Per Rectal Examination: A giant fecolith was detected. Investigations • Laboratory Findings: Leukocytosis (WBC 16,500/mm³, 83% neutrophils). • Imaging: ➢ Abdominal X-ray: Air bubble in the left hemithorax. ➢ Barium Esophagogram: Large type 3 hiatal hernia (Figure 1). CT Abdomen & Pelvis: Organoaxial gastric volvulus, type 3 paraesophageal hernia, fecal impaction in the sigmoid colon, and mesh erosion into the rectum (Figure 2). Passive left lung collapse noted. Figure 1: Barium swallow showing the gastroesophageal junction & stomach. Figure 2: Coronal CT scan showing migrated prolene mesh in the rectum (misdiagnosed as fecolith) Int. Jr. of Contemp. Res. in Multi. PEER-REVIEWED JOURNAL Volume 4 Issue 5 [SepOct] Year 2025 333 © 2025 Dr. Manju Singh, Dr. Amit Agrawal, Dr. Abhijeet Bhattacharya, Dr. Pooja Jain. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY NC ND).https://creativecommons.org/licenses/by/4.0/ TREATMENT The patient underwent open paraesophageal hernia repair with mesh hernioplasty and mesh removal via a transanal approach. Figure 3: Mesh Removal intraoperative Imaging Figure 4: Post Mesh Removal OUTCOME & FOLLOW-UP The patient had an uneventful recovery and was discharged on postoperative day 7. Follow-up showed complete symptom resolution. DISCUSSION Laparoscopic ventral mesh rectopexy is widely used for rectal prolapse, offering benefits such as reduced pain and hospital stay. However, mesh-related complications, including migration, have been reported. Studies indicate a higher incidence with synthetic mesh than biological mesh. The management of intrarectal mesh migration should be individualized based on mesh location, infection, and fibrosis. Laparoscopic Nissen fundoplication is a common procedure for GERD. However, paraesophageal herniation and gastric volvulus are rare but severe complications, often due to postoperative pain, gastric distension, or excessive fundus mobilization. Early dysphagia and vomiting postoperatively should raise suspicion of this condition. In this case, type 3 paraesophageal hernia and gastric volvulus occurred post-fundoplication, necessitating surgical intervention. CONCLUSION This case highlights the potential for delayed mesh migration following laparoscopic rectopexy. Surgeons should consider this possibility in patients with previous rectopexy presenting with abdominal symptoms. Paraesophageal hernia is a rare but serious complication after fundoplication. Early recognition and intervention are crucial for patient outcomes. REFERENCES 1. Patil NS, Saluja SS, Mishra PK, Solanki N, Parasar K. Intrarectal migration of mesh following rectopexy: Case series and review of literature. Int J Surg. 2015;20:145-8. doi:10.1016/j.ijsu.2015.06.055 2. Seelig MH, Hinder RA, Klingler PJ, Floch NR, Branton SA, Smith SL. Paraesophageal herniation as a complication following laparoscopic antireflux surgery. J Gastrointest Surg. 1999;3(1):95-9. doi:10.1016/S1091255X(99)80017-9 3. Consten ECJ, van Iersel JJ, Verheijen PM, Broeders IAMJ, Wolthuis AM, D’Hoore A. Long-term outcome after laparoscopic ventral mesh rectopexy. Ann Surg. 2015;262(5):742-8. doi:10.1097/SLA.0000000000001441 4. Balla A, Quaresima S, Smolarek S, Shalaby M, Missori G, Sileri P. Synthetic versus biological mesh-related erosion after laparoscopic ventral mesh rectopexy: A systematic Int. Jr. of Contemp. Res. in Multi. PEER-REVIEWED JOURNAL Volume 4 Issue 5 [SepOct] Year 2025 334 © 2025 Dr. Manju Singh, Dr. Amit Agrawal, Dr. Abhijeet Bhattacharya, Dr. Pooja Jain. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY NC ND).https://creativecommons.org/licenses/by/4.0/ review. Ann Coloproctol. 2017;33(2):46-51. doi:10.3393/ac.2017.33.2.46 5. Savolainen H, Lehtimäki T, Rantanen T. Gastric volvulus after laparoscopic Nissen fundoplication and hiatal closure performed due to giant hiatal hernia: A case report. J Case Rep Images Surg. 2015;1:13-6. 6. Marghich O, Benichou B, Amouzou EYO, Maubert A, Etienne JH, Benizri E, Rahili MA. Case series of mesh migration after rectopexy surgery for rectal prolapse. J Surg Case Rep. 2022;2022(2):rjac017. doi:10.1093/jscr/rjac017 7. Hinder RA, Klingler PJ, Perdikis G, Smith SL. Management of the failed antireflux operation. Surg Clin North Am. 1997;77(5):1083-98. doi:10.1016/S00396109(05)70512-3 8. Yvergneaux JP, Berghs B, Kint M. Paraesophageal hernia with acute intrathoracic volvulus of the stomach after laparoscopic Nissen fundoplication. Acta Chir Belg. 1996;96:280-3. Creative Commons (CC) License This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY 4.0) license. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. About the Corresponding Author Dr. Pooja Jain, aged 26, is a Resident Surgeon in the Department of General Surgery at Pt. JNM Medical College, Raipur, Chhattisgarh, India. She completed her MBBS from the same institution and possesses clinical expertise in general surgical procedures and patient care. Dr. Jain is dedicated to advancing surgical knowledge and contributing to medical research and practice in her field.