Large Paraesophageal Hiatal Hernia in a Patient With Chest Pain
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Gregory K. Wanner
A 78-year-old man with a history of coronary artery disease and type 2 diabetes mellitus presented to the emergency department with chest pressure and epigastric pain of 3 hours’ duration. He did not have shortness of breath. Associated symptoms included nausea, diaphoresis, and pain in the left side of his neck. Electrocardiogram findings and troponin level were unremarkable. A chest radiograph showed a large hiatal hernia (image A), and a computed tomographic image of the chest (image B) revealed a type II paraesophageal hernia, later determined to involve strangulation of the gastric fundus. The patient underwent hernia reduction, partial gastrectomy, and repair of the hiatus with synthetic mesh. His hospital stay was prolonged and complicated.
Hiatal hernias are categorized into 4 subtypes: sliding hernia (type I) is the most common type of hiatal hernia (95% of cases) and is rarely associated with severe complications. Paraesophageal hernias, however, involve herniation of the gastric fundus (type II and III) or, occasionally, other abdominal organs (type IV) and have at least an 18% lifetime risk of requiring emergent surgical correction.1-3 The estimated mortality rate of acutely symptomatic paraesophageal hiatal hernias (types II through IV) is 16.4% without and 3.2% with an emergent surgical procedure.2, 3 Complicated paraesophageal hernia should be considered in patients with chest or upper abdominal pain and a large retrocardiac air-fluid level visible on chest radiograph.1 (doi:10.7556/jaoa.2015.055)
References
1. Landreneau RJ ,Del PinoM,SantosR. Management of paraesophageal hernias [review].Surg Clin North Am.2005;85(3):411-432.10.1016/j.suc.2005.01.006Search in Google Scholar PubMed
2. Sihvo EI ,SaloJA,RäsänenJV,RantanenTK. Fatal complications of adult paraesophageal hernia: a population-based study.J Thorac Cardiovasc Surg.2009;137(2):419-424. doi:10.1016/j.jtcvs.2008.05.042.10.1016/j.jtcvs.2008.05.042Search in Google Scholar PubMed
3. Jassim H ,SeligmanJT,FrelichM, et al. A population-based analysis of emergent versus elective paraesophageal hernia repair using the Nationwide Inpatient Sample.Surg Endosc.2014;28:3473-3478. doi:10.1007/s00464-014-3626-3.10.1007/s00464-014-3626-3Search in Google Scholar PubMed PubMed Central
© 2015 American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles in the same Issue
- EDITORIAL
- The JAOA: Growing, Changing, Improving
- Transitions in Osteopathic Medical Education
- IN MY VIEW
- A Structural Examination of Medical Education Reform
- MEDICAL EDUCATION
- New Colleges of Osteopathic Medicine, Branch Campuses, and Additional Locations—What Is the Difference?
- IN MY VIEW
- Single Accreditation System: Opportunity and Duty to Promote Osteopathic Training for All Interested Residency Programs
- The CAST Model: Enhancing Medical Student and Resident Clinical Performance Through Feedback
- LETTERS TO THE EDITOR
- Challenges of Teaching Live and Distance Audiences Simultaneously
- MEDICAL EDUCATION
- Comparison of COMLEX-USA Scores, Medical School Performance, and Preadmission Variables Between Women and Men
- Developing Technology-Enhanced Active Learning for Medical Education: Challenges, Solutions, and Future Directions
- Innovative Approach to Teaching Osteopathic Manipulative Medicine: The Integration of Ultrasonography
- Relationship Between Residency Placement and Clerkship Site Enrollment: A Retrospective Analysis
- Comprehensive Osteopathic Medical Licensing Examination-USA Level 1 and Level 2-Cognitive Evaluation Preparation and Outcomes
- International Medical Graduates in the US Physician Workforce
- The Single Graduate Medical Education Accreditation System
- Osteopathic Postdoctoral Training Institutions' 2014 Annual Report
- Evolution of AOA Specialty Board Certification
- APPENDIX
- Appendix 1: Osteopathic Graduate Medical Education, 2015
- Appendix 2: American Osteopathic Association Specialty Board Certification
- Appendix 3: Colleges of Osteopathic Medicine
- CLINICAL IMAGES
- Large Paraesophageal Hiatal Hernia in a Patient With Chest Pain
Articles in the same Issue
- EDITORIAL
- The JAOA: Growing, Changing, Improving
- Transitions in Osteopathic Medical Education
- IN MY VIEW
- A Structural Examination of Medical Education Reform
- MEDICAL EDUCATION
- New Colleges of Osteopathic Medicine, Branch Campuses, and Additional Locations—What Is the Difference?
- IN MY VIEW
- Single Accreditation System: Opportunity and Duty to Promote Osteopathic Training for All Interested Residency Programs
- The CAST Model: Enhancing Medical Student and Resident Clinical Performance Through Feedback
- LETTERS TO THE EDITOR
- Challenges of Teaching Live and Distance Audiences Simultaneously
- MEDICAL EDUCATION
- Comparison of COMLEX-USA Scores, Medical School Performance, and Preadmission Variables Between Women and Men
- Developing Technology-Enhanced Active Learning for Medical Education: Challenges, Solutions, and Future Directions
- Innovative Approach to Teaching Osteopathic Manipulative Medicine: The Integration of Ultrasonography
- Relationship Between Residency Placement and Clerkship Site Enrollment: A Retrospective Analysis
- Comprehensive Osteopathic Medical Licensing Examination-USA Level 1 and Level 2-Cognitive Evaluation Preparation and Outcomes
- International Medical Graduates in the US Physician Workforce
- The Single Graduate Medical Education Accreditation System
- Osteopathic Postdoctoral Training Institutions' 2014 Annual Report
- Evolution of AOA Specialty Board Certification
- APPENDIX
- Appendix 1: Osteopathic Graduate Medical Education, 2015
- Appendix 2: American Osteopathic Association Specialty Board Certification
- Appendix 3: Colleges of Osteopathic Medicine
- CLINICAL IMAGES
- Large Paraesophageal Hiatal Hernia in a Patient With Chest Pain
