[Ulcers of the neck of hiatal hernias. 15 cases]

Of 450 patients treated for hiatus hernia, a review of case-reports showed ulcers of the neck in 15 patients (3,1%). Frequency of hemorrhage was high (13/15), and it was sometimes severe, one patient dying from massive bleeding preoperatively. Diagnosis was by radiology in 11 cases, by endoscopy in 3 and perioperatively in one case. Data on physiopathogenicity include both mechanical and chemical factors. Conservative treatment with repair of hiatus hernia combined or not with vagotomy was performed in 11 patients. Severity of hemorrhagic phenomena or absence of preoperative biopsy led to direct surgery on ulcer in 3 cases, while evidence of mediastinal inflammatory processes required major surgery in 1 patient and an upper pole esophagogastrectomy in another. Long-term follow up failed to show evidence of recurrence of ulcer or hemorrhage.