Concomitant Paraesophageal Parahiatal Hernia: a Rare Entity
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CASE REPORT
Concomitant Paraesophageal Parahiatal Hernia: a Rare Entity Poddar Anshuman 1 & Tantia Om 1 & Chaudhuri Tamonas 1 & Khanna Shashi 1 Received: 21 September 2020 / Accepted: 14 October 2020 # Association of Surgeons of India 2020
Abstract Paraesophageal hernia (PEH) is herniation of fundus of the stomach or very rarely other abdominal structures like colon/spleen through a hiatal opening in the diaphragm, usually towards the left side. PEH comprises about 3.5–5% of all hiatal hernias. They are more common in elderly population. Laparoscopic management of PEH is the preferred treatment of choice especially in elderly patients. The concomitant occurrence of parahiatal hernia (PH) with PEH is a very rare scenario with only a handful number of cases reported in the literature. A 72-year lady patient presented to us with chief complaints of pain abdomen in the right upper quadrant region and vomiting intermittently for the last 6 months. Upper GI endoscopy showed the presence of hiatal hernia with GE junction at 37 cm. The patient underwent laparoscopic repair of hiatus and paraesophageal hernia. The preoperative diagnosis of PH is difficult, a laparoscopic approach is helpful both as a diagnostic as well as therapeutic tool for treatment of PH. The various things to keep in mind while dealing with such rare cases are the patient’s profile, symptoms, expected complications and outcomes. Keywords Paraesophageal hernia (PEH) . Parahiatal hernia (PH) . Congenital diaphragmatic hernia (CDH)
Introduction Paraesophageal hernia (PEH) is herniation of fundus of the stomach or very rarely other abdominal structures through a hiatal opening in the diaphragm, usually towards the left side. It was first described by Akerlund in 1926 [1]. PEH comprises about 3.5–5% of all hiatal hernias [2]. They are more common in elderly population, and the symptoms are abdominal pain, chest pain, hiccough, regurgitation and dysphagia. Laparoscopic management of PEH is the preferred treatment of choice especially in elderly patients [3]. Diaphragmatic hernia is herniation of abdominal contents through the diaphragm into the chest. It can be congenital or * Tantia Om [email protected] Poddar Anshuman [email protected] Chaudhuri Tamonas [email protected] Khanna Shashi [email protected] 1
Department of Minimal Access & Bariatric Surgery, ILS Hospital, DD-6, Sector – I, Salt Lake City, Kolkata 700 064, India
acquired in nature. Congenital diaphragmatic hernia (CDH) is of following types: (a) Bochdalek hernia (BH), (b) MorgagniLarry hernia, (c) parahiatal hernia (PH) and (d) hernia through the central tendon. PH is a rare sub type of hiatal hernia in adults. The defect is present immediately adjacent to the anatomically normal oesophageal hiatus. The oesophageal hiatus is well separated from this defect by crural fibres. The concomitant occurrence of PH with PEH is a very rare scenario with only a handful number of cases reported in the literature [4]. Here, we present one such case of a patient having PEH with PH w
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