title: Volvulus of the liver with intrathoracic herniation.
abstract: BACKGROUND
  We present a rare case of a liver volvulus, stomach and transverse colon herniating through the diaphragm. This scenario has not been reported previously. We discuss the presentation and management of this interesting case.
  
  
  METHODS
  A 65-year-old woman with a history of sarcoidosis and recurrent pericardial effusions, treated previously with a subxiphoid pericardial oval window fenestration, presented with acute upper abdominal pain radiating to the chest. High contrast computed tomography showed a volvulus of the liver with consequent venous congestion, and herniation of the liver, stomach and transverse colon through an anterior diaphragmatic defect. With liver perfusion threatened, an urgent laparoscopic repair was performed. The stomach and transverse colon were reduced, and the twisted left lobe of the liver was unrotated and reduced into the abdominal cavity. A double-sided synthetic mesh was used to repair the defect. The patient made an uneventful recovery.
  
  
  CONCLUSIONS
  This is a novel complication of a patient presenting with abdominal pain with a previous history of pericardial window fenestration. A laparoscopic reduction and repair can be performed safely with excellent postoperative results.
authors.affiliation: Dudley Group NHS Foundation Trust, UK.
authors.forename: G
authors.initials: G
authors.lastname: Moussa
authors.forename: P M
authors.initials: PM
authors.lastname: Thomson
authors.forename: A
authors.initials: A
authors.lastname: Bohra
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods; D006801:Humans; D045822:Intestinal Volvulus / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008099:Liver; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000601:surgery; D010491:Pericardial Window Techniques / Q000009:adverse effects*; D011859:Radiography; D035583:Rare Diseases; D013277:Stomach Volvulus / Q000000981:diagnostic imaging / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome