Congenital paraesophageal hiatal hernia with intrathoracic gastric volvulus in an infant: a case report with radiographic sequence

Excerpt

Congenital paraesophageal hiatus hernia in children is a very rare condition, which may or may not be symptomatic [1‐4]. The symptomatology of these patients is usually non-specific, in the form of repeated attacks of chest infection and/or recurrent vomiting, but can be associated with serious complications such as intra-thoracic gastric volvulus with incarceration and strangulation [1, 2, 5]. Plain chest radiographs, AP and lateral, may raise a suspicion of the condition, while upper GI contrast series is diagnostic [2, 6, 7]. The treatment is surgical consisting of excision of the hernial sac after reducing the stomach and repair of the diaphragmatic defect by tightening the crura of the esophageal hiatus [1, 2]. If the defect is large and associated with displacement of GEJ into the thorax, adding an antireflux procedure to the repair is appropriate [7]. This can be achieved transabdominally either by laparotomy or laparoscopically [2, 3, 7]. Congenital paraesophageal hiatal hernia being a very rare condition in infants, and more so when associated with volvulus of the intrathoracic stomach, a case with classical radiographic presentation is reported. The classical clinical and radiographic features are discussed with an anatomical interpretation. …