Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report

Abstract

Background: Hiatal hernia is defined by the permanent or intermittent prolapse of any abdominal structure into the chest through the diaphragmatic esophageal hiatus. Prolapse of the stomach, intestine, transverse colon, and spleen is relatively common, but herniation of the pancreas is a rare condition. We describe a case of acute pancreatitis and bile duct dilatation secondary to a massive hiatal hernia of pancreatic body and tail. Case presentation: An 86-year-old woman with hiatal hernia who complained of epigastric pain and vomiting was admitted to our hospital. Blood tests revealed a hyperamylasemia and abnormal liver function test. Computed tomography revealed prolapse of the massive hiatal hernia, containing the stomach and pancreatic body and tail, with peripancreatic fluid in the posterior mediastinal space as a sequel to pancreatitis. In addition, intrahepatic and extrahepatic bile ducts were seen to be dilated and deformed. After conservative treatment for pancreatitis, an elective operation was performed. There was a strong adhesion between the hernial sac and the right diaphragmatic crus. After the stomach and pancreas were pulled into the abdominal cavity, the hiatal orifice was closed by silk thread sutures (primary repair), and the mesh was fixed in front of the hernial orifice. Toupet fundoplication and intraoperative endoscopy were performed. The patient had an uneventful postoperative course post-procedure. Conclusion: A rare massive hiatal hernia, involving the stomach and pancreatic body and tail, can cause acute pancreatitis with bile duct dilatation. The etiology can be flexure of the main pancreatic and extrahepatic bile ducts. Symptomatic herniation is best treated with surgery. Elective surgery is thought to be safer than emergent surgery in patients with serious complications.

Diaphragmatic hernia a rare cause of acute pancreatitis: Case report

“…Diaphragmatic hernias can be congenital, hiatal, or traumatic in origin, and they are defined by a transitory or persistent migration of abdominal contents into the thoracic cavity through a diaphragmatic defect [6] . with the exception of the stomach, the small intestine, spleen, and transverse colon are the organs least prone to hernias [1] . Because the head segment of the pancreas and duodenum are positioned in the retroperitoneum and held by Treitz' ligament, pancreatic herniation is extremely rare [3] .…”

“…Pancreatic herniation is a rare occurrence, with just 12 cases reported to date [3] . As a result of this mechanism, acute pancreatitis is extremely unusual, having been recorded in only 14 people previously [1] .…”

“…Post-traumatic diaphragmatic hernia is described as the permanent or intermittent prolapse of any abdominal structure into the mediastinum or thoracic cavity via the diaphragm apertures [1] . In the sixteenth century, Ambroise Pare reported this disease for the first time [2] .…”

Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review

“…When the patient is lying on their right side and performing Valsalva maneuvers, the increase of abdominal pressure will reduce the anti-reflux mechanism, which makes it easier to observe the situation of reflux. Because some small hernias or sliding hernias are often asymptomatic or manifest atypical symptoms and intermittent episodes, they are easily interfered by subjective factors, and thus routine ultrasound, X-ray radiography, endoscopy, and esophageal manometry are not readily able to facilitate a diagnosis[ 30 ]. For such patients, CEUS with the oral agent mixture can make up for the deficiencies of these routine examinations and can be beneficial for evaluation of small hernias and sliding hernias.…”

Double Heart-Shaped Silhouette

“…Hiatal hernias are characterized by the prolapse of abdominal contents, mainly the stomach and abdominal viscera, into the mediastinum or thoracic cavity through the hiatal orifice. 1 Hiatal hernia and esophageal dilatation sometimes coexist and are reported as predisposing factors for aspiration pneumonia. 2 Surgical intervention is indicated for hiatal hernia when the patient is symptomatic.…”