[Pulmonary complications of large, type 4 hiatal hernias]

Three patients, 63, 76 and 56-years-old, presented with pulmonary symptoms caused by a large, type 4 hiatal hernia. A woman was examined for dyspnoea, and CT scan revealed an intrathoracically herniated stomach and colon. A man with progressive dyspnoea and a lung function disorder seen during spirometry was found to have herniation of the stomach, omentum and transverse colon. The third patient, a man, was hospitalised with bilateral pneumonia and found to have a herniated stomach, transverse colon, and pancreas. Repair by laparoscopy was successful in the second patient, but was not possible and required conversion to laparotomy in the other two patients. In addition, re-laparotomy for gastric ischaemia was necessary in the first patient, and for significant stenosis of the distal oesophagus in the third patient. After surgery, pulmonary symptoms and lung function improved in all three patients. Although surgical reduction of large hiatal hernias improves pulmonary symptoms, this can be at the cost of substantial morbidity.