Paraesophageal Hernia
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《新英格兰医药杂志》
A 34-year-old woman with a nine-month history of postprandial dyspnea and substernal fullness had severe pain in her epigastrium, without emesis, shortly after the ingestion of an evening meal. On examination, she had audible bowel sounds, mild epigastric tenderness without rebound, and no palpable masses or organomegaly. A stool specimen was negative for occult blood. The results of laboratory tests were as follows: hemoglobin level, 12.8 g per deciliter; hematocrit, 37 percent; mean corpuscular volume, 86 μm3; and white-cell count, 7400 per cubic millimeter. Posteroanterior and lateral chest radiography revealed a large intrathoracic gastric bubble (Panels A and B), and a barium-contrast study of the upper gastrointestinal tract confirmed the presence of a large paraesophageal hernia (Panel C). A denotes gastric antrum, F gastric fundus, and P pylorus.
On endoscopic examination, no hemorrhage, mucosal damage, or esophagitis was found. An exploratory laparotomy revealed a large paraesophageal hernia (i.e., type II hiatal hernia), without evidence of gastric strangulation. The crura were repaired, and a Nissen fundoplication with anterior gastropexy was performed. The patient recovered from surgery uneventfully.
Robert J. Canter, M.D.
James P. Greelish, M.D.
University of Pennsylvania
Philadelphia, PA 19104
On endoscopic examination, no hemorrhage, mucosal damage, or esophagitis was found. An exploratory laparotomy revealed a large paraesophageal hernia (i.e., type II hiatal hernia), without evidence of gastric strangulation. The crura were repaired, and a Nissen fundoplication with anterior gastropexy was performed. The patient recovered from surgery uneventfully.
Robert J. Canter, M.D.
James P. Greelish, M.D.
University of Pennsylvania
Philadelphia, PA 19104