Severe Gas Bloat Syndrome and Gastric Ischemia: A Rare Complication of Toupet Fundoplication

Gas bloat syndrome (GBS) is a recognized complication of fundoplication, most commonly associated with the Nissen technique and rarely reported after Toupet fundoplication. We present a 42-year-old man who developed acute GBS with necrotic appearing gastric mucosa following Toupet fundoplication. Prompt endoscopic decompression and pyloric botulinum toxin injection led to rapid clinical and endoscopic improvement without surgical intervention. This case highlights that, although Toupet fundoplication reduces the risk of GBS, severe manifestations can still occur and require early recognition and timely management.