Perforated gastric corpus in a strangulated paraesophageal hernia: a case report

Abstract

Introduction: Patients with paraesophageal hernias often present secondary to chronic

symptomatology. Infrequently, acute intestinal ischemia and perforation can occur as a consequence

of paraesophageal hernias with potentially dire consequences.

Case presentation: An 86-year-old obtunded male presented to the emergency department with

hypotension and severe back and abdominal pain. An emergency abdominal CT scan was ordered

with a presumptive diagnosis of ruptured abdominal aortic aneurysm. CT topograms revealed

extensive free intra-abdominal air and herniated abdominal viscera into the right hemithorax. Prior to

completion of the CT study, the patient sustained a cardiopulmonary arrest. Surgery was consulted,

but the patient was unable to be revived. Post-mortem examination revealed gross contamination

within the abdomen and a giant, incarcerated, hiatal hernia with organoaxial volvulus and ischemic

perforation.

Conclusion: Current recommendations call for prompt repair of giant hiatal hernias before they

become symptomatic due to the increased risk of strangulation. Torsion of the stomach in large hiatal

hernias frequently leads to a fatal complication such as this warranting elective repair as soon as

possible. Originally published Journal of Medical Case Reports, Vol. 3, No. 6507, May 2009