de Schoutheete Jean-Charles, Reece-Smith Alex M, Wajed Saj A
a Department of Upper Gastro-Intestinal Surgery , Royal Devon and Exeter Hospital , Exeter , UK.
Acta Chir Belg. 2018 Apr;118(2):129-131. doi: 10.1080/00015458.2017.1316620. Epub 2017 Apr 19.
Herniation of abdominal viscera into the thorax may occur as a consequence of abnormal defects in the diaphragm. In adults, the most common condition relates to herniations through a weakened crural orifice via which the oesophagus normally traverses. These hiatus hernias are classified as types I-IV depending on the extent of visceral involvement.
We present here a case of type IV hiatus hernia with massive mediastinal herniation of the small bowel, yet remarkable in that the stomach itself remained completely intra-abdominal. Gastric outlet obstruction occurred as a consequence of extrinsic proximal small bowel compression.
To our knowledge this is the first reported case of paraoesophageal hernia exclusively involving small bowel, without involving any part of the stomach, and yet causing gastric outlet obstruction.
