Clinical Snapshot
Incarcerated Paraesophageal Hernia
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A 56-year-old female patient was referred to us due to a 2-day history of progressive epigastric pain and vomiting. Clinical examination revealed upper abdominal peritonism, septic circulatory parameters (HR 115/min, RR 87/68 mmHg), and respiratory insufficiency (SpO2 84%, paO2 60 mmHg). Chest X-ray showed a large air bubble on the left side of the thorax (arrow). On the basis of a suspected hiatus hernia, computed tomography of the chest was performed as part of the further diagnostic work-up, confirming an incarcerated paraesophageal hernia. Emergency laparotomy revealed purulent upper abdominal peritonitis and subtotal gangrene of the stomach incarcerated in the esophageal hiatus, as well as gangrene of the esophagogastric junction. Gastrectomy and distal esophageal resection with blind closure of the mediastinal esophagus were performed and a percutaneous jejunostomy placed for enteral feeding. After a convalescence period of 3 months, reconstruction of the alimentary tract was carried out by means of ileocecal interposition. This was followed by a complication-free course.
Dr. Jasmina Kuvendjiska, Prof. Dr. med. Stefan Fichtner-Feigl, Prof. Dr. med. Jens Hoeppner, Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, jasmina.kuvendjiska@uniklinik-freiburg.de
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Kuvendjiska J, Fichtner-Feigl S, Hoeppner J: Incarcerated paraesophageal hernia. Dtsch Arztebl Int 2020; 117: 832. DOI: 10.3238/arztebl.2020.0832
