Paraesophageal hernia

Migration of abdominal organs though the diaphragm at the esophageal hiatus.

A hiatal or paraesophageal hernia occurs when the GE junction, the stomach, or other abdominal organs such as the small intestine,: colon or spleen move up into the chest where they do not belong.

The stomach and other abdominal organs can be displaced into the mediastinum.

There are several types of paraesophageal hernias: type I is a hiatal or sliding hernia, in which the GE junction moves above the diaphragm, leaving the stomach in the abdomen and represents 95% of all paraesophageal hernias. Types II, III, and IV occur when part or all of the stomach and sometimes other organs move up into the chest.

More than half of the population has a hiatal or paraesophageal hernia.

Most people are symptom-free.

Hiatal hernia or paraesophageal hernias may cause reflux symptoms: heartburn, nausea, burping, vomiting, regurgitation of food, unexplained upper abdominal or chest pain, a sense of fullness after eating, bloating, shortness of breath or coughing, or a sense of food getting stuck in the chest.

Severe symptoms occur when the bowel or stomach twists or loses its blood supply: heart palpitations, shortness of breath, chest pain, severe vomiting, lack of bowel movements and severe andominal pain-and this may require immediate medical attention.

Can be associated with incarceration or gastric volvulus.

Associated with a 1% cumulative annual incidence of strangulation.

Association with strangulation results in a mortality rate of 5.4%.

Diagnosis may be made incidentally during imaging of a chest x-ray, CT or MRI.

Barium swallow examination or an upper endoscopy visualizes the anatomy of the stomach and esophagus.

Treatment depends on the type of hernia and severity of symptomatology.

Type I hiatal hernias are typically managed with medication for reflux do not require of the treatment.

Type II and III hernias may require surgery if they become symptomatic.

In type IV hernias when organs such a small bowel, colon, pancreas are trapped in the chest, surgery is often necessary.

Surgery may be approach from the abdomen or from the chest.

Surgery may be minimally invasive or require open surgery.

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