Parahiatal Hernia Complicated with Gastric Volvulus: Report of a Case

Satoshi Hasegawa, Yoshihiro Suzuki, Yukihiko Hiroshima, Yasunobu Yamazaki and Hideyuki Ike

Department of Surgery, Saiseikai Yokohama City Nanbu Hospital

We report a case of parahiatal hernia. An 86-year-old woman reporting sudden left-sided chest and upper abdominal pain but having no history of chest trauma was found in chest X-ray to have gastroenteric gas that overlapping the left lower lung field. An upper gastrointestinal series showed organoaxial gastric volvulus, mostly protruding into the left thoracic cavity. Magnetic resonance imaging (MRI) showed that the stomach and part of the transverse colon had migrated into the left thoracic cavity, indicating a paraesophageal hernia with gastric volvulus was preoperatively diagnosed. Laparotomy found a diaphragmatic defect lateral to the left crus of the diaphragm after the stomach and transverse colon were reduced into the abdomen. The 6.0×5.0 cm hernia orifice was separated from the esophageal hilus, and the crus of diaphragm was located between the hilus and the hernia orifice. The definitive diagnosis was a parahiatal hernia, a type of diaphragmatic hernia. The diaphragmatic defect was sutured and closed. She was discharged without complication. Parahiatal hernias, which are so rare that their existence is doubted, they are characterized by the presence of distinct crus of diaphragmatic between an anatomically normal esophageal hiatus and the diaphragm defect.

Key words
parahiatal hernia, gastric volvulus

Reprint requests
Satoshi Hasegawa Department of Gastroenterological Surgery, Yokohama City University
3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JAPAN

Accepted
April 22, 2009

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