A surgical emergency due to an incarcerated paraesophageal hernia

Paraesophageal hernias (PEHs) are hernias in which the gastroesophageal junction stays where it belongs (attached at the level of the diaphragm), but part of the stomach passes or bulges into the chest beside the esophagus. It represents a small proportion of all hiatal hernias. It can lead to severe complications like incarceration, volvulus, or strangulation, which are true emergencies in the emergent department (ED). Paraesophageal hernia rarely features on a list of differential diagnoses of acute chest or epigastric pain. It could be treated as myocardial insult, and the outcome could be life-threatening. Thus, it is easily missed when ED physicians did not maintain a high index of suspicion. Multislice thoracoabdominal computed tomography scan is a very useful and reliable tool for diagnosis and detecting complications. Surgical repair of PEH provide excellent outcomes and have low complication rate compared with laparoscopic approach in the literature. Correct diagnosis and treatment can prevent life-threatening complications. We reported a case of PEH with incarceration of stomach and colon with initial presentations of nonspecific epigastralgia and anterior chest pain. It highlights the challenge that noncardiac chest pain presents to the ED physician.