Zielińska Zofia, Ruszecka Anna, Kęska Mateusz, Czajkowski Wojciech
Thoracic Surgery, Jagiellonian University Medical College, Kraków, POL.
Medical and Health Sciences, Jagiellonian University Medical College, Kraków, POL.
Cureus. 2024 Sep 13;16(9):e69375. doi: 10.7759/cureus.69375. eCollection 2024 Sep.
A sliding hiatal hernia is a frequent pathology. Its prevalence increases with age. However, incarceration of such hernias is a very rare phenomenon with a lack of precise data in the literature. Should this condition occur, it requires immediate surgical intervention. We report a case of a 95-year-old female presenting with thoracic pain and general state deterioration. The patient was otherwise relatively stable on admission. Causes of cardiac origin were excluded. A plain chest X-ray and a chest computed tomography (CT) revealed a giant sliding incarcerated hiatal hernia. Urgent laparotomy was performed, and the hernia strangulation was confirmed. The rim of the esophageal hiatus was cut to enable the repositioning of the stomach. No necrosis was found. The hiatal crura was approximated with sutures, and the Nissen fundoplication was performed successfully with no postoperative complications. The patient was discharged in good condition. Surgical procedures in the elderly pose a great challenge due to numerous risk factors, such as polypharmacy, comorbidities, and frailty syndrome. However, an incarcerated hiatal hernia is a condition that necessitates urgent surgery, either through laparoscopy or laparotomy. It can be easily missed, mimicking cardiac symptoms. In this case, the ailment was successfully diagnosed, the laparotomy approach was chosen, and the Nissen fundoplication was performed to prevent possible gastroesophageal reflux disease (GERD).
滑动性食管裂孔疝是一种常见的病理情况。其患病率随年龄增长而增加。然而，此类疝的嵌顿是一种非常罕见的现象，文献中缺乏精确的数据。一旦出现这种情况，需要立即进行手术干预。我们报告一例95岁女性患者，表现为胸痛和全身状况恶化。患者入院时其他方面相对稳定。排除了心脏源性病因。胸部X线平片和胸部计算机断层扫描（CT）显示巨大的滑动性嵌顿食管裂孔疝。进行了紧急剖腹手术，证实存在疝绞窄。切开食管裂孔边缘以使胃复位。未发现坏死。用缝线将食管裂孔肌脚对合，成功进行了nissen胃底折叠术，术后无并发症。患者康复出院。由于多种风险因素，如多种药物治疗、合并症和衰弱综合征，老年患者的手术操作面临巨大挑战。然而，嵌顿性食管裂孔疝是一种需要通过腹腔镜或剖腹手术进行紧急手术的疾病。它很容易被误诊，表现类似心脏症状。在本病例中，该疾病被成功诊断，选择了剖腹手术方法，并进行了nissen胃底折叠术以预防可能的胃食管反流病（GERD）。
