Pediatric Nissen Fundoplication Malfunction

  • Etiology: Occurs after Nissen fundoplication surgery for gastroesophageal reflux
  • Imaging:
  • DDX:
  • Complications:
    — Complete esophageal obstruction at the gastroesophageal junction due to the Nissen fundoplication being too tight
    — Partial or complete dehiscence of the Nissen fundoplication resulting in resumption of gastroesophageal reflux
    — Para-Nissen herniation where a portion of the stomach herniates above the Nissen fundoplication
  • Treatment: Surgical
  • Clinical:
    — Para-Nissen herniations commonly present with retching

Radiology Cases of Nissen Fundoplication Malfunction

Radiology Cases of Nissen Fundoplication Malfunction Due to Para-Nissen Herniation

Upper GI of para-Nissen herniation
AP (left) and lateral (right) images from an upper GI exam show the Nissen fundoplication wrap to be intact around the fundus of the stomach. However, part of the stomach has herniated above the level of the wrap.
UpperGI of para Nissen herniation
AP (left) and lateral (right) images from an UpperGI exam show the Nissen fundoplication wrap is intact. However, a small portion of the stomach has herniated superiorly and posteriorly through the wrap into the chest. This is best seen on the lateral view.