Patel Shruti, Shahzad Ghulamullah, Jawairia Mahreema, Subramani Krishnaiyer, Viswanathan Prakash, Mustacchia Paul
Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Nassau University Medical Center, East Meadow, NY 11554, USA.
Case Rep Med. 2016;2016:2531925. doi: 10.1155/2016/2531925. Epub 2016 Mar 15.
Hiatal hernia (HH) is the herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm. A giant HH with pancreatic prolapse is very rare and its causing pancreatitis is an even more extraordinary condition. We describe a case of a 65-year-old man diagnosed with acute pancreatitis secondary to pancreatic herniation. In these cases, acute pancreatitis may be caused by the diaphragmatic crura impinging upon the pancreas and leading to repetitive trauma as it crosses the hernia; intermittent folding of the main pancreatic duct; ischemia associated with stretching at its vascular pedicle; or total pancreatic incarceration. Asymptomatic hernia may not require any treatment, while multiple studies have supported the recommendation of early elective repair as a safer route in symptomatic patients. In summary, though rare, pancreatic herniation should be considered as a cause of acute pancreatitis. A high index of suspicion for complications is warranted in cases like these.
食管裂孔疝（HH）是腹腔内容物通过膈肌食管裂孔的疝出。巨大食管裂孔疝合并胰腺脱垂非常罕见，其引发胰腺炎更是一种极为特殊的情况。我们描述了一例65岁男性患者，诊断为胰腺疝出继发急性胰腺炎。在这些病例中，急性胰腺炎可能由以下原因引起：膈肌脚压迫胰腺，当其穿过疝时导致反复创伤；主胰管间歇性折叠；与血管蒂拉伸相关的缺血；或胰腺完全嵌顿。无症状疝可能无需任何治疗，而多项研究支持对有症状患者早期择期修复是更安全的途径这一建议。总之，虽然罕见，但胰腺疝出应被视为急性胰腺炎的一个病因。对于此类病例，有必要对并发症保持高度怀疑指数。
