Clinical Images  |   March 2018
Strangulated Paraesophageal Hiatal Hernia
Author Notes
  • From the Advocate Lutheran General Hospital in Park Ridge, Illinois. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Ryan Hoff, DO, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068-1143. Email: ryan.hoff@advocatehealth.com
     
Article Information
Gastroenterology / Imaging / Ophthalmology and Otolaryngology / Pulmonary Disorders / Clinical Images
Clinical Images   |   March 2018
Strangulated Paraesophageal Hiatal Hernia
The Journal of the American Osteopathic Association, March 2018, Vol. 118, 207. doi:10.7556/jaoa.2018.042
The Journal of the American Osteopathic Association, March 2018, Vol. 118, 207. doi:10.7556/jaoa.2018.042
A 76-year-old man was admitted to the hospital with nonexertional epigastric pain radiating to the lower chest. His medical history included gastroesophageal reflux disease. Plain-film (single view) radiographic chest images demonstrated a large hiatal hernia (image A). A nothing-by-mouth diet was prescribed, but the patient continued to have significant epigastric discomfort. Nasogastric intubation resulted in drainage of 3 L of gastric secretions. Computed tomographic images without contrast demonstrated a large strangulated paraesophageal hernia (image B, arrow). The patient underwent robotic-assisted laparoscopic repair of the hernia with surgical mesh. His postoperative course was complicated by sepsis, which resolved after a short course of cefepime. 
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