Giant hiatus hernia in a young person: an unusual case report

Giant paraesophageal hernia is an uncommon condition that typically affects older adults and may rarely progress to gastric ischemia or necrosis. A 28-year-old man with no prior comorbidities, trauma, reflux symptoms, or known hiatal hernia is presented. He developed acute intolerance to oral intake, left upper quadrant pain, unproductive retching, dyspnea, fever, tachycardia, and hypoxemia. Imaging demonstrated a giant paraesophageal hernia with 70%-80% of the stomach herniated into the thoracic cavity, without evidence of gastric volvulus. Urgent exploratory laparotomy revealed extensive gastric gangrene extending to the antrum. Total gastrectomy with Roux-en-Y esophagojejunostomy and primary diaphragmatic repair were performed. The postoperative course was favorable, and oral intake was resumed after confirmation of an intact anastomosis. This case demonstrates that life-threatening gastric gangrene can occur in young adults with paraesophageal hernia, even in the absence of volvulus.