Images in clinical medicine | Volume 37, Article 86, 24 Sep 2020 | 10.11604/pamj.2020.37.86.26141

Giant hiatal hernia

Danilo Coco, Silvana Leanza

Corresponding author: Danilo Coco, Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy

Received: 18 Sep 2020 - Accepted: 19 Sep 2020 - Published: 24 Sep 2020

Domain: General surgery

Keywords: Giant hiatal hernia, diaphragmatic hernia, volvulus

©Danilo Coco et al. Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this article: Danilo Coco et al. Giant hiatal hernia. Pan African Medical Journal. 2020;37:86. [doi: 10.11604/pamj.2020.37.86.26141]

Available online at: https://www.panafrican-med-journal.com/content/article/37/86/full

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Images in clinical medicine

Giant hiatal hernia

Giant hiatal hernia

Danilo Coco1,&, Silvana Leanza2

 

1Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy, 2Department of General Surgery, Carlo Urban Hospital, Jesi, Ancona (Italy)

 

 

&Corresponding author
Danilo Coco, Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy

 

 

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A Giant Hiatal Hernia (GHH) is a type III hernia with a sliding and para esophageal component such as > 30% of the stomach, colon, spleen or pancreas due a chronic positive pressure on the diaphragmatic hiatus. Surgical repair requires hernia sac excision, tension-free repair and Nissen fundoplication. Recurrence rates range between 2% and 12%. A 77 years old Caucasian woman presented to the ED with significant thoracic pain, vomiting and bradycardia (<50 bpm). She presented a medical history of atrial fibrillation and anticoagulant therapy. She reported a traumatic rupture of the sternum 5 years ago. Her vital signs were: blood pressure 130/70 mmHg, respiratory rate 40 breaths/minute, heart rate 129 beats/minute and temperature superior of 36 C. Oxygen saturation was 85% on room air. The abdominal examination was normal. Thoracic examination reported reduced vesicular murmur. Laboratory evaluation revealed high leukocytosis with a white blood cell (WBC) count of 16 per mm3. Arterial Blood Gases (ABG) demonstrated metabolic acidosis. Computed Tomography revealed a Giant Hiatal Hernia with stomach, ileum and colon in thoracic cavity. The patient was immediately started intravenous (IV) fluids of 2l in 6 hours, Foley and jugular catheter vein cannulation to support main arterial pressure and urine output. The patient was discussed for surgical operations.

 

 

Figure 1: computed tomography revealed a giant hiatal hernia with stomach, ileum and colon in thoracic cavity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Images in clinical medicine

Giant hiatal hernia

Images in clinical medicine

Giant hiatal hernia

Images in clinical medicine

Giant hiatal hernia

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Key words

Giant hiatal hernia

Diaphragmatic hernia

Volvulus

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