IS Case 97: Type III Paraesophageal Hernia

Nate Johnson, MD

Imaging Sciences URMC 2008
Publication Date: 2009-05-20

History

A 71-year-old female presents with complaint of long-standing GERD and a history of a retrocardiac density on chest x-ray suspicious for hiatal hernia.

Diagnosis

Type III Paraesophageal Hernia

Discussion

There are 3 major types of hiatal hernias:

Type I: Gastroesophageal junction located above the diaphragm.

Type II: Fundus of the stomach located above the diaphragm. GE junction below diaphragm.

Type III: Both GE junction and portion/all of stomach above the diaphragm.

Symptoms may include GERD, epigastric pressure, postprandial dyspnea and/or vomiting. Complications that may arise include gastritis, ulceration and bleeding into the hernia secondary to venous and lymphatic obstruction causing hemorrhagic/edematous rugal folds.

The most dreaded complication is strangulation of the hernia sac which can occur in 30% of patients with a Type III (paraesophageal) hernia. This is suspected when there is acute worsening of abdominal pain. Secondary to this potentially fatal condition Type III hernias usually require surgical repair.

Our patient underwent surgery after these images with good results.

References

  1. Magill MK, Gazak C. Paraesophageal hernia and intrathoracic diverticulitis. J Am Board Fam Pract. 2000 Mar-Apr;13(2):141-3. [PMID: 10764198]
  2. Johnson CD, Schmit GD. Mayo Clinic: Gastrointestinal Imaging Review. Rochester, MN: Mayo Clinic Scientific Press, 2005.

2 images