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
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