Successful Hiatal Hernia Repair in a 95-Year-Old Patient: A Case Report

A sliding hiatal hernia is a frequent pathology. Its prevalence increases with age. However, incarceration of such hernias is a very rare phenomenon with a lack of precise data in the literature. Should this condition occur, it requires immediate surgical intervention. We report a case of a 95-year-old female presenting with thoracic pain and general state deterioration. The patient was otherwise relatively stable on admission. Causes of cardiac origin were excluded. A plain chest X-ray and a chest computed tomography (CT) revealed a giant sliding incarcerated hiatal hernia. Urgent laparotomy was performed, and the hernia strangulation was confirmed. The rim of the esophageal hiatus was cut to enable the repositioning of the stomach. No necrosis was found. The hiatal crura was approximated with sutures, and the Nissen fundoplication was performed successfully with no postoperative complications. The patient was discharged in good condition. Surgical procedures in the elderly pose a great challenge due to numerous risk factors, such as polypharmacy, comorbidities, and frailty syndrome. However, an incarcerated hiatal hernia is a condition that necessitates urgent surgery, either through laparoscopy or laparotomy. It can be easily missed, mimicking cardiac symptoms. In this case, the ailment was successfully diagnosed, the laparotomy approach was chosen, and the Nissen fundoplication was performed to prevent possible gastroesophageal reflux disease (GERD).