Duodenum in the right hemithorax: An unusual case of a large paraesophageal hernia

Abstract

Paraesophageal hernia is an uncommon condition where the gastric fundus herniates through the diaphragm without the accompanied migration of the gastroesophageal junction. A woman in her late 60s presented with symptoms of vomiting and decreased appetite for 1 year, accompanied by abdominal fullness in the epigastrium, nausea, and retrosternal burning sensation. Her symptoms worsened over the past month, leading to intolerance to a liquid diet. Upon examination, a vague, tender mass was palpated over the epigastrium, and decreased breath sounds were noted over the right hemithorax. Computed tomography suggested the presence of paraesophageal hernia. An exploratory laparotomy was performed. Intraoperatively, a 4cm paraesophageal diaphragmatic defect was found through which the antrum and the first part of the duodenum had herniated. The hernial contents were reduced, and anatomical closure was performed. Paraesophageal hernias necessitate careful history and examination, along with an individualized treatment approach, to achieve optimal patient outcomes.

Keywords

Hernia / hiatal hernia / large paraesophageal hernia / paraesophageal hernia

References

[1] Mazer L , Telem DA . Paraesophageal hernia. Adv Surg 2021; 55: 109- 22.

[2] Landreneau RJ , Del Pino M , Santos R . Management of paraesophageal hernias. Surg Clin North Am 2005; 85: 411- 32.

[3] Takeuchi N , Nomura Y . Paraesophageal hernia with incarceration of the gastric antrum and duodenal bulb: A case report. BMC Res Notes 2013; 6: 451.

[4] Dellaportas D , Papaconstantinou I , Nastos C , Karamanolis G , Theodosopoulos T . Large paraesophageal hiatus hernia: Is surgery mandatory? Chirurgia (Bucur) 2018; 113: 765- 71.

[5] Mugino M , Little SC , Van der Wall H , Falk GL . High incidence of dyspnoea and pulmonary aspiration in giant hiatus hernia: A previously unrecognised cause of dyspnoea. Ann R Coll Surg Engl 2022; 104: 530- 7.

[6] Oude Nijhuis RAB , van der Hoek M , Schuitenmaker JM , Schijven MP , Draaisma WA , Smout AJPM , et al. The natural course of giant paraesophageal hernia and long-term outcomes following conservative management. United Eur Gastroenterol J 2020; 8: 1163- 73.

[7] Eero IS , Jarmo AS , Jari VR , Rantanen TK . Fatal complications of adult paraesophageal hernia: A population-based study. J Thorac Cardiovasc Surg 2009; 137: 419- 24.

[8] Cardile AP , Heppner DS . Gastric volvulus, Borchardt’s triad, and endoscopy: A rare twist. Hawaii Med J 2011; 70: 80- 2.

[9] Haurani C , Carlin AM , Hammoud ZT , Velanovich V . Prevalence and resolution of anemia with paraesophageal hernia repair. J Gastrointest Surg 2012; 16: 1817- 20.

[10] Lebenthal A , Waterford SD , Fisichella PM . Treatment and controversies in paraesophageal hernia repair. Front Surg 2015; 2: 13.

[11] Collet D , Luc G , Chiche L . Management of large para-esophageal hiatal hernias. J Visc Surg 2013; 150: 395- 402.

[12] Zehetner J , Demeester SR , Ayazi S , Kilday P , Augustin F , Hagen JA , et al. Laparoscopic versus open repair of paraesophageal hernia: The second decade. J Am Coll Surg 2011; 212: 813- 20.

[13] Klinginsmith M , Jolley J , Lomelin D , Krause C , Heiden J , Oleynikov D . Paraesophageal hernia repair in the emergency setting: Is laparoscopy with the addition of a fundoplication the new gold standard? Surg Endosc 2016; 30: 1790- 5.

RIGHTS & PERMISSIONS

2024 International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow