Paraesophageal hernia with incarceration of the gastric antrum and duodenal bulb

Case contributed by Yahya Baba
Diagnosis certain

Presentation

Admitted to the intensive care unit for respiratory distress.

Patient Data

Age: 75 years
Gender: Female

Herniation of the gastric antrum and duodenal bulb into the middle mediastinum on the right side of the esophagus, through the esophageal hiatus above a normally positioned gastro-esophageal junction

Esophageal and gastric dilatation, with duodenal narrowing at the exiting point

Left lower lobe and inferior lingular consolidation with air bronchogram and volume loss.

There is no portal venous gas. No intramural bowel gas.

Normal parietal enhancement.

Case Discussion

A paraesophageal hernia, also known as a rolling hiatus hernia, is an uncommon type of hiatus hernia in which there is upward herniation of the gastric fundus or antrum.

This case demonstrates a paraesophageal hernia (type II) with the incarceration of the gastric antrum and duodenal bulb, complicated by esophageal dilatation and aspiration pneumonia. The main differential diagnosis for this case was gastric volvulus, but there is no rotation of the stomach around the short or long axis.

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