J Korean Surg Soc.  2010 Mar;78(3):195-198. 10.4174/jkss.2010.78.3.195.

Paraesophageal Hernia with Small Bowel Strangulation

• Lee JW
• Kim HS
• Ryu BY
• Kim HK
• Han SJ

• KMID: 2211949
• DOI: http://doi.org/10.4174/jkss.2010.78.3.195

Abstract

Paraesophageal hernias are usually classified into three distinct types: type I, sliding hernias; type II, paraesophageal hernias; type III, a combination of type I and II. Herniation of other abdominal organs can be classified as type IV, and is a rare situation at the esophageal hiatus. We report herein a 73-year-old female patient who presented with epigastric pain and diagnosed as type IV paraesophageal hernia. Initial evaluation was focused on myocardial ischemia. There was no evidence of myocardial ischemia in the coronary angiography, but follow-up chest X-ray revealed air-fluid levels in the left mediastinum suggested hiatal hernia. On computed tomography, herniation and strangulation of proximal jejunum into the hemithorax via left diaphragmatic defect was found. After reduction of small bowel and resection of strangulated segment, the defect was closed. Fluid collection in the hernia sac was detected at postoperative day nine, but she was discharged without complication.

Keyword

Paraesophageal hernia; Small bowel; Strangulation

MeSH Terms

Aged
Coronary Angiography
Female
Follow-Up Studies
Hernia
Hernia, Hiatal
Humans
Jejunum
Mediastinum
Myocardial Ischemia
Thorax

Figure

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  Fig. 1 Chest PA/lateral Jejunal dilatation in upper abdomen with air-fluid level in left mediastinum (arrow).

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  Fig. 2 Abdomen CT. Herniation of proximal jejunum into the hemithorax via left diaphragmatic defect. Diffuse fluid filled small bowel dilatation with suggested distal small bowel obstruction (arrow).

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  Fig. 3 Intra-operative images revealing diaphragmatic defect (arrow).

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