Acute appendicitis with large complex para-oesophageal hiatus hernia
Patient presented with acute abdominal pain localised to the right iliac fossa, anorexia and a raised C-reactive protein.
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Appendix was noted to have a thickened wall that was hyperaemic in keeping with acute appendicitis. Incidental finding of a large para-oesophageal hiatus hernia containing the entire stomach and the majority of the transverse colon.
The patient underwent routine emergency laparoscopic appendicectomy without complication. With regard to the large para-oesophageal hernia, the patient was completely unaware of this prominent incidental finding. In retrospect, the patient felt she had become increasingly short of breath over a period of 12 months. On review of imaging by a general surgeon it was thought that the finding was likely of longstanding and that surgical repair would be difficult.