Hiatus Hernia

Case contributed by Dr John Li

Presentation

Elderly female with 2 year history of back pain radiating to the epigastrium, presented with worsening pain and vomiting.

Patient Data

Age: 90
Gender: Female
X-ray

Moderate sized hiatus hernia.

 

CT

No organo-axial positioning of the stomach within the left thoracic cavity which may be acute or chronic.  No fat stranding, pneumatosis or perforation is detected.  There is associated herniation of the splenic flexure, although no obstructive features involving the colon.  As a result of the abnormal position of the stomach the distal antrum/pyloric region is mildly compressed which may impact gastric emptying. 

Case Discussion

The organo-axial positioning of the stomach does not exceed 180 degree to be diagnosed as a gastric volvulus. However, it's orientation and herniation into the thoracic cavity puts it at risk of strangulation.  There is narrowing of the distal antrum/pyloric region which may impair gastric emptying.  This could be formally assessed with a gastric emptying study or barium swallow.  If there are features to suggest acute gastric volvulus surgical review is advised. 

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Case information

rID: 59327
Published: 4th Apr 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: Gold Coast University Hospital

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