HIATAL HERNIA

Question 1

Type I (2)

Answer 1

• Sliding hiatal hernia associated with GERD and results from sliding of the gastroesophageal junction (cardia of stomach) into the chest through esophageal hiatus in the diaphragm
• If asymptomatic can be observed because of the low risk of incarceration. Surgical intervention can be used and is similar to that of GERD

Question 2

Type II (3)

Answer 2

• Paraesophageal hernia caused by isolated sliding of the stomach (fundus) into the thorax with preservation of the GE junction
• Higher risk of incarceration and ischemia so management of asymptomatic patients is controversial (some prefer elective repair, others prefer observation and patient education)
• Treatment indicated in symptomatic patients with reduction, reconstruction of diaphragmatic defect, fundoplication, and anchoring of the stomach with a gastrostomy tube or gastropexy

Question 3

Others

Answer 3

Type III —> combination of sliding and para-esophageal hernia
Type IV —> herniation of other organs e.g. colon, spleen, omentum

Question 4

Diagnosis (3)

Answer 4

1- Chest radiography: shows air in mediastinum
2- Contrast Upper GI swallow (gold standard) —> confirms advanced hiatal hernia
3- CT scan can provide further detail on anatomy of the hernia