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Incarcerated paraesophageal hernia complicated by pancreatic damage and unusual comorbidity: Two retrospective case

H M Haug1, E Johnson2, T Mala1

  • 1Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Ullevål, P.O. box 4950, 0424 Oslo, Norway.

International Journal of Surgery Case Reports
|December 12, 2018
PubMed

Insights

Paraesophageal hernias (PEH) can cause life-threatening complications. Early diagnosis and intervention are crucial for managing incarcerated PEH, especially in patients with risk factors like trisomy 21 or hereditary spastic paresis.

Area of Science:

  • Gastroenterology
  • Surgical Case Reports

Background:

  • Paraesophageal hernias (PEH) rarely require emergency surgery, typically due to obstruction or gangrene.
  • Two complex cases of incarcerated PEH are presented, highlighting diagnostic and management challenges.

Purpose of the Study:

  • To illustrate the critical nature of incarcerated paraesophageal hernias (PEH).
  • To emphasize the importance of early diagnosis and intervention in high-risk patients.

Main Methods:

  • Case presentation of two patients with incarcerated PEH: an 18-year-old with trisomy 21 and a 65-year-old with hereditary spastic paresis.
  • Diagnostic imaging (CT scans) and surgical interventions including laparoscopy, endoscopy, gastrectomy, and Roux-en-Y reconstruction were employed.
  • Management involved addressing complications such as gastric dilation, organ compression, perforation, intestinal obstruction, and wound dehiscence.

Main Results:

  • The first patient required laparoscopic repositioning, endoscopic deflation, and ultimately a gastrectomy, followed by reoperation for complications.
  • The second patient, initially hemodynamically unstable with gastric perforation, underwent subtotal gastrectomy and later a completed gastrectomy with Roux-en-Y reconstruction, recovering after managing wound dehiscence.

Conclusions:

  • Trisomy 21 and hereditary spastic paresis may be associated with an increased risk of PEH.
  • Diagnostic delays due to symptom evaluation challenges can occur.
  • Urgent diagnosis and gastric deflation are vital to prevent ischemic and mechanical damage from gastric compression of adjacent structures.
Abstract

Keywords:
Case seriesIncarcerated paraesophageal herniaIschemiaPancreatic fistula

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