Mejri Atef, Arfaoui Khaoula, Yaacoubi Jasser, Ayadi Mohamed Firas
Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Department of General Surgery, Jendouba Hospital, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Int J Surg Case Rep. 2022 Jul;96:107328. doi: 10.1016/j.ijscr.2022.107328. Epub 2022 Jun 20.
Hiatal hernia (HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon, even rarer when HH is associated with acute pancreatitis.
A 56-year-old female with hypertension and gastroesophageal reflux disease presented with abdominal pain, vomiting and chest discomfort evolving for 24 h. Physical examination revealed left-upper quadrant tenderness without guarding. Blood tests showed elevated serum amylase and lipase levels. An abdominal CT scan demonstrated a large type-IV hiatal hernia involving the entire stomach, transverse and right colon, small intestine, duodenum as well as the head, body and the tail of pancreas. The pancreas was enlarged consistent with pancreatitis. Patient clinical status improved with conservative treatment.
The stomach is the most common organ to herniate through the diaphragm and pancreatic herniation is extremely rare with only few cases in the literature. Even rarer when associated with acute pancreatitis. This diagnosis is a major diagnostic and therapeutic challenge that has to be evoked in elderly presenting with chest pain and a negative cardiopulmonary evaluation. The ideal treatment is still unclear, however, conservative treatment is the initial management and surgery may be considered in case of recurrent episodes of acute pancreatitis.
HH associated with acute pancreatitis is a major diagnostic and therapeutic challenge. Clinicians should consider this rare diagnosis in every case of chest pain with negative cardiopulmonary evaluation.
食管裂孔疝（HH）的内容物通常包括胃、横结肠、小肠和脾脏，但胰腺疝出是一种极为罕见的现象，当HH与急性胰腺炎相关时则更为罕见。
一名56岁患有高血压和胃食管反流病的女性，出现腹痛、呕吐和胸部不适24小时。体格检查发现左上腹压痛，无肌紧张。血液检查显示血清淀粉酶和脂肪酶水平升高。腹部CT扫描显示一个大型IV型食管裂孔疝，累及整个胃、横结肠和右结肠、小肠、十二指肠以及胰腺的头部、体部和尾部。胰腺肿大，符合胰腺炎表现。患者经保守治疗后临床状况改善。
胃是最常见通过膈肌疝出的器官，胰腺疝出极为罕见，文献中仅有少数病例报道。与急性胰腺炎相关时更为罕见。对于出现胸痛且心肺评估阴性的老年人，这种诊断是一项重大的诊断和治疗挑战。理想的治疗方法仍不明确，然而，保守治疗是初始治疗手段，若急性胰腺炎反复发作可考虑手术治疗。
HH合并急性胰腺炎是一项重大的诊断和治疗挑战。对于每例胸痛且心肺评估阴性的患者，临床医生都应考虑这种罕见的诊断。
