Complications of paraesophageal hiatal hernia
Hemorrhage
Strangulation ( Gastric volvulus)
Obstruction
Gastric stasis ulcer ( Cameron lesions- causes iron deficiency anemia)
Investigation of Paraesophageal Hiatal Hernia
Upper Gastrointestinal Series
Contrast solution is swallowed and X-rays
are used to identify the presence of a hiatal hernia.Upper Endoscopy
A gastroscope is used to evaluate the esophagus and stomachCT Scan
Useful especially for evaluation of a paraesophageal hernias to identify the size of the hernia and other organs which may be involved.
CT Scan
Treatment Of Paraesophageal Hiatal Hernia
Paraesophageal hiatal hernia is treated surgically.
Indications for surgery
Nausea/ Vomiting
No bowel movement
Gastric volvulus/ Strangulation
Severely incompetent LES
Paraesophageal hernia
Surgical procedures for P.H.H
Hiatal Hernia repair The Surgeon will;
i.Reduce the stomach and other content of the hernia into the abdominal cavity
ii.Excise the hernia sac
iii.Repair the defect on the diaphragm
Anti-reflux procedure e.g Fundoplication
Gastropexy: Suturing the stomach to anterior abdominal wall
PEG (Percutaneous endoscopic gastrostomy): Usually in elderly patients at high surgical risk.
Complications Of Surgical treatment
Intraabdominal infectionEsophageal perforationDysphagia
Belching difficultyBloating (gas bloat syndrome)
Self limiting within 2-4 wks, but may persist
Summary
Protrusion of intra-abdominal contents through an enlarged esophageal hiatus of the diaphragm.
Risk factors include obesity, increased intra-abdominal pressure, and a previous hiatal operation.
May be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anemia or hematemesis, or some combination of these.
Contrasted upper GI series (also known as an upper GI or as a barium esophagram) is the key investigation.
Treatment depends on the patient's symptoms and the anatomic configuration of the hernia.
Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.
Complications include obstruction, bleeding, volvulus with and without strangulation or necrosis, and Barrett esophagus.