Shafii Alexis E, Agle Steven C, Zervos Emmanuel E
J Med Case Rep. 2009 May 7;3:6507. doi: 10.1186/1752-1947-3-6507.
Patients with paraesophageal hernias often present secondary to chronic symptomatology. Infrequently, acute intestinal ischemia and perforation can occur as a consequence of paraesophageal hernias with potentially dire consequences.
An 86-year-old obtunded male presented to the emergency department with hypotension and severe back and abdominal pain. An emergency abdominal CT scan was ordered with a presumptive diagnosis of ruptured abdominal aortic aneurysm. CT topograms revealed extensive free intra-abdominal air and herniated abdominal viscera into the right hemithorax. Prior to completion of the CT study, the patient sustained a cardiopulmonary arrest. Surgery was consulted, but the patient was unable to be revived. Post-mortem examination revealed gross contamination within the abdomen and a giant, incarcerated, hiatal hernia with organoaxial volvulus and ischemic perforation.
Current recommendations call for prompt repair of giant hiatal hernias before they become symptomatic due to the increased risk of strangulation. Torsion of the stomach in large hiatal hernias frequently leads to a fatal complication such as this warranting elective repair as soon as possible.
食管旁疝患者常因慢性症状而就诊。食管旁疝偶尔会导致急性肠缺血和穿孔，可能产生严重后果。
一名86岁意识不清的男性因低血压及严重的背部和腹痛被送往急诊科。急诊腹部CT扫描检查，初步诊断为腹主动脉瘤破裂。CT平扫显示腹腔内大量游离气体，腹腔脏器疝入右胸腔。在CT检查完成前，患者发生心肺骤停。会诊外科，但患者未能复苏。尸检发现腹腔内严重污染，巨大的嵌顿性食管裂孔疝伴器官轴扭转和缺血性穿孔。
目前的建议是，鉴于绞窄风险增加，对于巨大食管裂孔疝，应在出现症状前尽早进行修复。大型食管裂孔疝的胃扭转常导致致命并发症，因此需要尽早进行择期修复。
