A woman in her late 80s visited a local physician complaining of nausea, loss of appetite, and constipation. She was referred to our hospital for detailed examination. Computed tomography (CT) revealed that the entire stomach, pancreas, spleen, transverse colon, and small intestine were prolapsed into the mediastinum and left thoracic cavity through the esophageal hiatus, which was dilated. Moreover, the small intestine was narrowed at the hiatus and dilated in the abdominal cavity, presenting ileus. After diagnosing type IV esophageal hiatal hernia with upside-down stomach and starting conservative treatment, the ileus improved and oral intake was resumed. Subsequent CT showed continued prolapse of the pancreas, spleen, transverse colon, small intestine, and entire stomach, but CT taken 5 years earlier had shown similar findings of prolapse. Thus, we decided not to perform surgery and instead opted for close follow-up after discharge. The patient is well without any symptoms of obstruction as of 1.5 years after discharge.

A woman in her 70s was referred to our hospital for epigastric pain. CT showed a 3-cm mass slightly below the cardia. At her request, we adopted a strategy of watchful waiting, but 2 years later CT and endoscopy revealed that the mass had grown to 3.5 cm, and single-incision laparoscopic intragastric resection was performed. The day after surgery, hematemesis was observed. Upper gastrointestinal endoscopy revealed oozing from the staple line at the tumor resection site, and hemostasis was performed. Oral intake was started on postoperative day 4, and the patient was discharged from the hospital on postoperative day 10. The final pathology results showed a low-risk gastrointestinal stromal tumor (GIST). Three years after surgery, there has been no evidence of passage obstruction or recurrence. We discuss the indications and techniques for single-incision laparoscopic intragastric resection and review the literature.