78 years old male, diabetic, hypertensive, recent R.Hemiplegia, presented with haemetemesis and malaena. Has had two similar bleeds over the past one month, managed elsewhere. EGD showed very severe oesophagitis with erosions and ulcers, bleeding. After stabilisation, repeat EGD showed a hiatus hernia with a chronic gastric volvulus in a larger than normal stomach. The volvulus almost shuts off the distal stomach. (possibly resulting in the severe reflux)
A minimally invasive procedure to anchor the stomach is called for.