Hiatus hernia containing stomach, pancreas, splenic flexure, omentum and vessels

Case contributed by Dr Craig Hacking

Presentation

Retrosternal and epigastric pain, vomiting.

Patient Data

Age: 87
Gender: Female

Chest

Large hiatus hernia containing the entire stomach (which is not distended nor volved), body and tail of pancreas, large bowel (splenic flexure), omentum and vessels (including the splenic artery and vein). Normal enhancement of the stomach wall. Scarring in the lung apices. No suspicious lung nodule or mass. Right pleural thickening. Dependant collapse in the lung bases. No pleural effusion. No lymphadenopathy. Cardiomegaly. No pericardial effusion.

Abdomen and Pelvis

Intrahepatic biliary dilatation. The CBD measures up to 13mm is more prominent than expected this age group and post-cholecystectomy status. Dilated pancreatic duct within the pancreatic head (6mm). Air and fluid filled duodenal diverticulum. Calcified liver granulomas. Subcentimetre hypodense right kidney lesions too small to definitively characterise on CT but are likely cysts.The spleen, left kidney and adrenal glands are normal. Colonic faecal loading. No lymphadenopathy, free fluid or gas. 2.7cm x 2.2cm x 3.0cm left adnexal mass, possibly ovarian in origin although the left ovary is not identified.

Skeletal

Degenerative change without destructive osseous lesion. Lumbar scoliosis, convex to the left.

Conclusion

  1. Large hiatus hernia containing the entire stomach, pancreas, large bowel, omentum and vessels. No peripancreatic fat stranding to suggest pancreatitis although I note serum lipase is elevated. Whilst the stomach does not appear volved on this study the presence of retching is a concerning clinical feature for volvulus.
  2. Intra and extrahepatic biliary dilatation.
  3. 3cm left adnexal cystic lesion may be ovarian in origin and could be further assessed with pelvic ultrasound.

Case Discussion

Massive hiatus hernia containing several abdominal structures.

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Case information

rID: 36875
Case created: 14th May 2015
Last edited: 3rd Sep 2015
Inclusion in quiz mode: Included

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