A case of omental herniation through the esophageal hiatus successfully treated by laparoscopic surgery

Abstract

CaseWe report a rare case of omental herniation through the esophageal hiatus. A 46‐year‐old man visited our emergency department complaining of epigastralgia. Abdominal examination revealed muscular defense and rebound tenderness in his upper abdomen. A computed tomography scan showed a fat density mass in the posterior mediastinum. A laparoscopic operation was carried out under the diagnosis of omental herniation through the esophageal hiatus.OutcomeAbdominal pain disappeared dramatically after the operation. The postoperative course was uneventful.ConclusionAlthough a fat density mass in the posterior mediastinum is likely to be diagnosed as a lipomatous tumor, omental herniation through the esophageal hiatus should be taken into consideration as a possible diagnosis for acute abdominal pain in the emergency department.

What Is Your Diagnosis?

“…However, we clearly identified the hernia and location of important vessels with the use of pre-and postcontrast CT, which is superior in identifying omental vessels. 1,2,4 A large volume of inflamed omental fat with prominent blood vessels tightly packed in the caudal mediastinum possibly contributed to the soft tissue opacity seen on radiographic examination of this cat. The exact cause for rupture of the hernia sac was unknown, but a potential trigger for the sac to rupture might have been the catfight 2 days before examination.…”

“…To our knowledge, only 1 report describes omental herniation through the esophageal hiatus in a cat, 1 and there are a few case reports of such herniation in humans. 2,3 Risk factors of omental herniation through esophageal hiatus in people include increased age, obesity, and pregnancy, which might be associated with a reduction of elastic fibers in the phrenoesophageal membrane. 3 The commonalities between the cat of the present report and the affected cat previously reported 1 were older age and omental fat herniation into the mid caudodorsal region of the thorax.…”

Gastric outlet obstruction secondary to omental fat in a parahiatal hernia resulting in a gastric volvulus

“…Extrinsic causes can usually be managed with nasogastric decompression, followed by further work‐up and definitive management of underlying cause. In patients who have evidence of omental herniation through the oesophageal hiatus, surgery should be considered due to the risk of development of a gastric volvulus and its subsequent complications 8 . The same recommendation should apply for omental herniation through a PH.…”

“…In patients who have evidence of omental herniation through the oesophageal hiatus, surgery should be considered due to the risk of development of a gastric volvulus and its subsequent complications. 8 The same recommendation should apply for omental herniation through a PH. In the literature, majority of cases were managed laparoscopically.…”