ABSTRACT

Type IV paraesophageal hernias are rare, clinical presentation varies from asymptomatic to mild symptoms thought patients with bowel obstruction or gastric volvulus with severe symptoms. We present a clinical case of a 39 old female patient who starts with abdominal pain of 3 days of evolution, gets into our hospital with clinical data of bowel obstruction. Only history of appendicectomy 18 years ago. At the admission, the paraclinic studies shows a complicated diaphragmatic hernia with bowel obstruction, performing surgery within the first 24 hours, finding a left paraesophageal defect of 8 x 7 cm with contents of colon, stomach and incarcelated omentum without data of bowel suffering. Post surgery diagnosis was type IV paraesophageal hiatal hernia. Post surgery evolution was satisfactory, leaving the hospital on the seventh day after surgery. Clinical and radiological control at the month after de surgery was successful.
Conclusions: Para hiatal hernia is a rare entity which diagnosis is generally incidental by finding in the study for other reasons. The treatment is surgical thought open surgery or laparoscopic, once the necessary studies are performed. In case of presence of complications as incarcelation or gastric volvulus, surgical management is urgently, in case of not performing, mortality is elevated.

KEYWORDS

Hiatal hernia, paraesophageal hiatal hernia.

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