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BY-NC-ND 4.0 license Open Access Published by De Gruyter March 1, 2018

Strangulated Paraesophageal Hiatal Hernia

Ryan Hoff and Baseer Qazi

A 76-year-old man was admitted to the hospital with nonexertional epigastric pain radiating to the lower chest. His medical history included gastroesophageal reflux disease. Plain-film (single view) radiographic chest images demonstrated a large hiatal hernia (image A). A nothing-by-mouth diet was prescribed, but the patient continued to have significant epigastric discomfort. Nasogastric intubation resulted in drainage of 3 L of gastric secretions. Computed tomographic images without contrast demonstrated a large strangulated paraesophageal hernia (image B, arrow). The patient underwent robotic-assisted laparoscopic repair of the hernia with surgical mesh. His postoperative course was complicated by sepsis, which resolved after a short course of cefepime.

Paraesophageal hernias are less common and more severe than sliding hernias. Symptoms may include chest pain, abdominal pain, or respiratory distress. The rate of progression to symptoms is about 14% per year.1 Complications include obstruction, bleeding, strangulation, perforation, respiratory compromise, and gastric volvulus.1 All symptomatic and any complicated paraesophageal hiatal hernias should be surgically repaired, usually laparoscopically.1 Surgical repair improves quality of life and mortality rates,2 and recurrences are rare.3


From the Advocate Lutheran General Hospital in Park Ridge, Illinois.
Financial Disclosures: None reported.
Support: None reported.

*Address correspondence to Ryan Hoff, DO, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068-1143. Email:


References

1. Kohn GP , PriceRR, DeMeesterSR, et al. Guidelines for the management of hiatal hernia. Surg Endosc. 2013;27(12):4409-4428. doi:10.1007/s00464-013-3173-3Search in Google Scholar PubMed

2. Le Page PA , FurtadoR, HaywardM, et al. Durability of giant hiatus hernia repair in 455 patients over 20 years. Ann R Coll Surg Engl. 2015;97(3):188-193. doi:10.1308/003588414X14055925060839Search in Google Scholar PubMed PubMed Central

3. White BC , JeansonneLO, MorgenthalCB, et al. Do recurrences after paraesophageal hernia repair matter? ten-year follow-up after laparoscopic repair. Surg Endosc. 2008;22(4):1107-1111. doi:10.1007/s00464-007-9649-2Search in Google Scholar PubMed

Received: 2017-01-30
Accepted: 2017-02-06
Published Online: 2018-03-01
Published in Print: 2018-03-01

© 2018 American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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