Bowel obstruction secondary to type IV hiatal hernia: a case report
DOI:
https://doi.org/10.18203/2320-6012.ijrms20222280Keywords:
Hiatal hernia, Acute paraesophageal hernia, Large bowel obstruction, Type 4 hiatal herniaAbstract
Hiatal hernias are classified into four types. Type 4 hernias are not limited to the stomach alone, but involve herniation of the omentum, colon, small intestine, peritoneum, pancreas, or spleen into the chest cavity. Account for less than 5% of all cases. The probability that a patient with a paraesophageal hernia will develop acute symptoms and require emergency surgery is 1.16% per year. We present a case of acute paraesophageal hiatal hernia repair in a patient who developed large bowel obstruction. An 82-year-old female was admitted to emergency room referring abdominal distension, intolerance to the oral intake, vomiting of fecal content, as well as impossibility to pass gas or evacuate. On physical evaluation with tachycardia and acute abdomen, laboratory studies showed leukocytosis, radiographic data of intestinal obstruction, and at the level of the left hemithorax, space occupation by the colon was evident. An emergency surgery was performed finding paraesophageal hernia with involvement of the stomach and transverse colon, and retrograde dilatation of the ascending and transverse colon with ischemic changes. The patient presented hemodynamic instability, so an extended right hemicolectomy was decided, with distal closure, ileostomy, and hiatal plasty performed. She was discharged on postoperative day four without complications. Type 4 hiatal hernia complicated with intestinal obstruction is a condition that carries high rates of morbidity and mortality, so early surgery is mandatory to avoid a fatal outcome for the patient. There are currently no clear guidelines regarding the management of acute complicated paraesophageal hernias.
References
Yu H, Han C, Xue J, Han Z, Xin H. Esophageal hiatal hernia: Risk, Diagnosis and Management. Expert Review of Gastroenterology & Hepatology. Taylor & Francis. 2018;319-29.
Patel S, Yarra S, Owji S, Benavidez JE, Nguyen QD. Minding the Gap: Clinical Manifestations of a Rare Type IV Hiatal Hernia. Cureus. 2020;12(7).
Markar SR, Mackenzie ÃH, Huddy JR, Jamel ÃS, Askari ÃA, Faiz O, et al. Practice Patterns and Outcomes After Hospital Admission With Acute Para-esophageal Hernia in England. Ann Surg. 2016; 264:854-61.
Buenaventura P, Abbas G, Wilson A, Grabo D, Virginia W. Incarcerated paraesophageal hernia and gastric volvulus: Management options for the acute care surgeon, an Eastern Association for the Surgery of Trauma master class video presentation. J Trauma Acute Care Surg. 2020;88(6):146-8.
Rajkomar K, Berney CR. Large hiatus hernia: time for a paradigm shift? BMC Surg. 2022;22(1):1-14.
Paul G, Raymond K, Price R, Demeester SR, Richardson WS, Stefanidis D, et al. Guidelines for the management of hiatal hernia. Surg Endosc. 2013;27:4409-28.
Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Rep. 2019;92(4):321-5.
Dreifuss NH, Schlottmann F. Management of paraesophageal hernia review of clinical studies: timing to surgery, mesh use, fundoplication, gastropexy and other controversies. Dis Esophagus. 2020;33:1-9.
Arevalo G, Wilkerson J, Saxe J. Acute Paraesophageal Hernia: Laparoscopic Repair With Adjunct T-Fastener Gastropexy for the High Operative Risk Patient. Surg Laparosc Endosc Percutan Tech. 2018;28(2):123-7.
Fleming AM, Scheckel B V, Kristin E, Yakoub D. Giant Paraesophageal Hernia With Obstructing Splenic Flexure Mass in the Left Hemithorax. Am Surg. 2021;1-3.