Esophago-gastric invagination in patients with sliding hiatus hernia

Abstract

Intussusception of the distal esophagus into a reducible hiatus hernia is described in nine female and three male patients. The main radiographic feature is demonstration of a lobulated fundal mass of changeable size and configuration surrounding the narrowed distal esophageal segment. This pseudotumor is produced by inversion of the hiatus hernia into the stomach, and may be mistaken for a neoplasm. Disinvagination invariably occurs when maneuvers directed toward demonstration of a sliding hernia are utilized during upper gastrointestinal fluoroscopy. It is emphasized that esophago-gastric invagination frequently accounts for masses shown in the cardia of older women with intermittent dysphagia and crampy epigastric pain.

Oesophagogastric invagination

“…All of these conditions can cause irregular peristalsis of the alimentary tract, which may lead to invagination or its reverse. 1 Radiological diagnosis of oesophagogastric invagination presents a formidable problem because the condition usually further alters the position of anatomical landmarks. (This distortion of anatomy already occurs to a certain extent in cases of SHH.)…”

Prevalence and clinical picture of gastroesophageal prolapse in gastroesophageal reflux disease

“…Only radiological documentation was available in these cases. Blum et al 14,20,21 . also identified a few cases in the medical literature of secondary sliding of the fundic mucosa (prolapse) or a portion of the fundic wall (intussusception) into the terminal esophagus 14,22 .…”

“…Blum et al 14,20,21 . also identified a few cases in the medical literature of secondary sliding of the fundic mucosa (prolapse) or a portion of the fundic wall (intussusception) into the terminal esophagus 14,22 . In 1985, Myllärniemi 23 defined GE prolapse as ‘a new type of sliding hiatus hernia,’ which is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus with a valve mechanism on the lower esophageal sphincter 13,23 that prevents further reflux from the stomach.…”

“…The prolapse was usually a transient phenomenon and resolved before the barium swallow test. In the double‐contrast phase of the barium swallow test, the distension of the gastric fundus helped differentiate the prolapse from a true polyp or from intussusceptions of the esophagus into a gastric hernia 14 (Fig. 2).…”

Radiologic features of carcinomas arising in hiatal hernias.

“…It has been noted that tumors arising in sliding hiatal hernias are difficult to recognize [1 , 5-7]. Adequate distension of such hernias may be difficult to achieve because of the incompetent lower esophageal sphincter, which causes further difficulties in differentiating the tumor from inflamed folds in the herniated segment, a frequent association with pseudotumors attributable to esophagogastnic invagination or mucosal prolapse, and distorted anatomic landmarks attributable to reducible hernias [14]. Recognition of the tumor before surgery is important because even during hiatal hernia repair, the surgeon may overlook a carcinoma [15].…”