Asymptomatic isolated partial hiatal herniation of the pancreas: MDCT evaluation and anatomical explanation: Case report and review of literature

Abstract

Isolated herniation of the pancreas through a gastroesophageal hiatus is an extremely rare condition, and only one case has been reported in the world literature. We describe a MDCT diagnosis of isolated partial hiatal hernia containing the body of a normal pancreas in an asymptomatic patient, give an anatomical explanation and review the corresponding literature.

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

“…They have been reported in congenital [11,15,18] and acquired hernias [3,4,6,10,12,14,16,19,20], but also as rare longterm complication after both transhiatal and transthoracic esophagectomy [8,9]. Even isolated (possibly congenital) herniation of just the pancreas [2] and transient pancreatic herniation have been reported [6,14].…”

“…When the colon and small intestine are herniated, stretching of transverse mesocolon may allow mobilization of the pancreas after lengthening of the posterior adhering fascia [2,6]. In a recent human cadaver study, researchers found retropancreatic fascia lining the posterior aspect of the body of the pancreas but were unable to locate the anterior renal fascia, possibly due to degeneration of the adrenal gland with ageing [7].…”

“…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].…”

“…A type II hernia is characterized by herniation of the gastric fundus into the mediastinum adjacent to the esophagus with the GE-junction still in the correct position. In type III (mixed) hiatal hernia, at least 30% of the stomach is herniated along with the GE-junction [1,2]. Only a type IV giant hiatal hernia (0.3%) and congenital hernias (0.2%) are characterized by herniation of additional organs besides the stomach.…”

Transhiatal Herniation of the Pancreas: An Extremely Rare Situation

“…The fusion fascia is termed the fascia of Treitz behind the head and the fascia of Toldt behind the body and tail of the pancreas. 2,3 The ablation of this fusion is possible and reversible as is the case during pancreaticoduodenectomies (Kocher maneuver).…”