Laparoscopic Repair of an Incarcerated Parahiatal Hernia with Gastric Necrosis: A Rare Case Report

Primary parahiatal hernias are rare in adults. We report the case of a young woman with a parahiatal hernia without obvious predisposing factors that resulted in gastric fundus necrosis.

A 34-year-old woman had experienced intermittent chest pain for 2 months but had not sought medical attention. She developed sudden-onset left chest pain without a history of trauma, with the pain worsening on inspiration. Her previous physician suspected a left lung abscess and referred her to our facility. Contrast-enhanced CT revealed a cavity with internal air above the diaphragm in the left thoracic cavity, which was continuous with the stomach in the abdominal cavity. We diagnosed an incarcerated diaphragmatic hernia with gastric ischemia and proceeded with emergency laparoscopic surgery. Intraoperatively, the gastric fundus was found to be incarcerated in the left diaphragm, and the hernial orifice was located just to the left of the esophageal hiatus. A diagnosis of parahiatal hernia was confirmed. The incarcerated gastric fundus was repositioned into the abdominal cavity. The hernial orifice was closed using nonabsorbable barbed sutures, and the necrotic gastric fundus was resected. The postoperative course was uneventful, and the patient was discharged on POD 13. CT at the 1-month follow-up revealed no recurrence of the parahiatal hernia.

Parahiatal hernia is extremely rare but may be life-threatening if diagnosed late. In this case, laparoscopic repair and resection of the necrotic gastric fundus were successfully performed.