Acute Pancreatitis Secondary to an Incarcerated Paraoesophageal Hernia: A Rare Cause for a Common Problem

Abstract

This is a rare case report of acute pancreatitis secondary to a massive incarcerated paraoesophageal hernia. The pathogenesis resulted from obstruction of the distal pancreatic duct after displacement of the pancreatic head and body into the thorax as part of a Type IV paraoesophageal hernia. Although this condition is rare, the patient made steady progress following laparotomy and open repair of hernia. She made a good recovery after prompt therapy, therefore, this report can be a guide to the diagnosis and treatment of similar conditions.

An Unusual Cause of Abdominal Pain in an Elderly Woman

“…Colon, small intestine, omentum, and spleen are the most commonly herniated organs and associated complications that have been reported include gastric volvulus with or without perforation, incarceration or strangulation of small or large bowel, and acute appendicitis in the setting of malrotation and splenic torsion. 1 Herniation of pancreas has been described in a few case reports. 2,3 Pancreatitis occurring secondary to this event are rare and is a rather uncommon cause of pancreatitis.…”

Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature

“…In the last 25 years, 17 cases of intrathoracic herniation of (parts of) the pancreas have been reported ( [4,10,11,[16][17][18][19], vomiting [17,18], dysphagia [4] or dyspnea [2,16,20]. Five cases, however, were diagnosed with pancreatitis secondary to intrathoracic pancreatic herniation [3,6,[13][14][15], one of which was associated with pancreatic torsion [6]. While pancreatitis is known to occur as a result of pancreatic herniation, large and giant hiatal hernia without pancreatic involvement may also present with acute or recurrent pancreatitis.…”

“…While pancreatitis is known to occur as a result of pancreatic herniation, large and giant hiatal hernia without pancreatic involvement may also present with acute or recurrent pancreatitis. The underlying mechanism is believed to be that of intermittent ischemia due to traction on the vascular pedicle [3,14,15], repetitive trauma associated with pancreatic movement across the hernia [3] or torsion with occlusion of the main pancreatic duct [6].…”

“…Only a type IV giant hiatal hernia (0.3%) and congenital hernias (0.2%) are characterized by herniation of additional organs besides the stomach. The most frequently herniated organs are the colon, small intestine, omentum, or spleen [3,4].…”

A Rare Case of Pancreatitis From Pancreatic Herniation

“…Table 1 [3,[7][8][9][10][11][12][13][14][15] lists the cases of acute pancreatitis from pancreatic herniation in hiatal hernias from published literature. All cases were diagnosed based on exclusion of other etiologies for acute pancreatitis.…”