Hiatal Hernia From Misdiagnosis to Diagnosis
Complications of hiatal hernia are potentially lethal, and surgical intervention is necessary. This matter is more important in cases that have ambiguous symptoms and are diagnosed with a delay. Such patients may experience life-threatening course and events. Accordingly, in this report, a 23-year-old male patient with unusual findings is presented. A 23-year-old male patient with acute dyspnea and fever was admitted in infectious disease ward with diagnosis of empyema according to chest radiography and CT-scan findings (Figures 1 and 2). On physical examinations the right lung sounds were normal, and the left lung sounds could not be heard. Then a gastrography was performed because of suspicion to hiatal hernia based on physical examination findings showing the presence of stomach in the thorax (Figure 3). In the surgery, the stomach and the transverse colon were released and reputed in the abdomen (Figure 4). The diaphragm was primarily repaired due to small defect, and the patient was discharged after 4-5 days with good general conditions. This case had a learning note that in the case of acute dyspnea with a positive history of stab wound to the chest, hiatal hernia should be considered as an important diagnosis and in these cases performing a gastrography would help physicians to make true and certain diagnosis and therapeutic decision.
Larusson HJ, Zingg U, Hahnloser D, Delport K, Seifert B, Oertli D. Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity. World J Surg 2009;33:980-5.
Ellis FH Jr, Crozier RE, Shea JA. Paraesophageal hiatus hernia Arch Surg 1986;121:416-20.
Salvador R, Dubecz A, Polomsky M, Gellerson O, Jones CE, Raymond DP, et al. A new era in esophageal diagnostics: the image-based paradigm of high-resolution manometry. J Am Coll Surg 2009;208:1035-44.
el-Serag HB, Sonnenberg A. Comorbid occurrence of laryngeal or pulmonary disease with esophagitis in United States military veterans. Gastroenterology 1997;113:755-60
Mittal RK, Lange RC, McCallum RW. Identification and mechanism of delayed esophageal acid clearance insubjects with hiatus hernia. Gastroenterology 1987;92:130-5.
Waring JP, Lacayo L, Hunter J, Katz E, Suwak B. Chronic cough and hoarseness in patients with severe gastroesophageal reflux disease. Diagnosis and response to therapy. Dig Dis Sci 1995;40:1093-7.
Perrin-Fayolle M, Gormand F, Braillon G, Lombard-Platet R, Vignal J, Azzar D, et al. Long-term results of surgical treatment for gastroesophageal reflux in asthmatic patients. Chest 1989;96:40-5.
Hiatt GA. The roles of esophagoscopy vs. radiography in diagnosing benign peptic esophageal strictures. Gastrointest Endosc 1977;23:194-5.
DeMeester TR, Peters JH, Bremner CG, Chandrasoma P. Biology of gastroesophageal reflux disease: pathophysiology relating to medical and surgical treatment. Ann Rev Med 1999;50:469-506.
Sihvo EI, Salo JA , Räsänen JV, Rantanen TK. Fatal complications of adult paraesophageal hernia a population-based study. J Thorac Cardiovasc Surg 2009;137:419-24.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.