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Congenital paraesophageal hiatal hernia: pitfalls in the diagnosis and treatment.
J Pediatr Surg. 2005 Jul; 40(7):1128-33.JP

Abstract

PURPOSE

The aim of this study was to analyze pitfalls in the diagnosis and treatment of congenital paraesophageal hiatal hernia (PEHH).

METHODS

Between 1992 and 2004, the records of 5 infants with PEHH were retrospectively reviewed for age, sex, presenting symptoms, radiological studies, operative findings and approaches, and outcomes.

RESULTS

All cases (3 male, 2 female) had right-sided hernias. They had clinical features of recurrent chest infections and intermittent vomiting that were present since birth in 3. Three presented acutely ill with findings of respiratory distress and vomiting. Three were referred with misdiagnoses of reflux disease, thoracic mass, and bronchopneumonia. On the chest x-rays of 3 cases, there were paracardiac opacities suggesting a mass lesion. According to the upper gastrointestinal series and/or computed tomography findings, 4 cases had a combination of sliding and paraesophageal hernia, and the remainder one had pure rolling hiatus hernia. Three had obstruction owing to organoaxial volvulus and required an emergency operation. All cases had a large hernia orifice. Four had gastroesophageal junction (GEJ) displaced into the thorax, and in 3, the stomach was found to be twisted, and transverse colon with omentum was also in the thorax in 2. In the remainder, the GEJ was in its normal position with herniated stomach. None of the cases had normal gastrosplenic and gastrocolic ligaments. Surgical repair included resection of the sac, closure of the hiatal defect, and Thal procedure. Two had intestinal malrotation, with right ovarian torsion and ventricular septal defect, respectively. Postoperative ventilation was required in one who later died. At a mean follow-up of 2 years, the other 4 had no symptoms related to the disease, and no evidence of recurrence or reflux was noted on control upper gastrointestinal series.

CONCLUSION

Congenital PEHH may be difficult to diagnose. It is frequently complicated and associated with morbidity and even mortality. If the defect is large and associated with displacement of GEJ into the thorax, adding an antireflux procedure to the repair is appropriate.

Authors+Show Affiliations

Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey. mimamoglu61@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

16034757

Citation

Imamoğlu, Mustafa, et al. "Congenital Paraesophageal Hiatal Hernia: Pitfalls in the Diagnosis and Treatment." Journal of Pediatric Surgery, vol. 40, no. 7, 2005, pp. 1128-33.
Imamoğlu M, Cay A, Koşucu P, et al. Congenital paraesophageal hiatal hernia: pitfalls in the diagnosis and treatment. J Pediatr Surg. 2005;40(7):1128-33.
Imamoğlu, M., Cay, A., Koşucu, P., Ozdemir, O., Orhan, F., Sapan, L., & Sarihan, H. (2005). Congenital paraesophageal hiatal hernia: pitfalls in the diagnosis and treatment. Journal of Pediatric Surgery, 40(7), 1128-33.
Imamoğlu M, et al. Congenital Paraesophageal Hiatal Hernia: Pitfalls in the Diagnosis and Treatment. J Pediatr Surg. 2005;40(7):1128-33. PubMed PMID: 16034757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Congenital paraesophageal hiatal hernia: pitfalls in the diagnosis and treatment. AU - Imamoğlu,Mustafa, AU - Cay,Ali, AU - Koşucu,Polat, AU - Ozdemir,Oğuzhan, AU - Orhan,Fazil, AU - Sapan,Levent, AU - Sarihan,Haluk, PY - 2005/7/22/pubmed PY - 2006/7/13/medline PY - 2005/7/22/entrez SP - 1128 EP - 33 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 40 IS - 7 N2 - PURPOSE: The aim of this study was to analyze pitfalls in the diagnosis and treatment of congenital paraesophageal hiatal hernia (PEHH). METHODS: Between 1992 and 2004, the records of 5 infants with PEHH were retrospectively reviewed for age, sex, presenting symptoms, radiological studies, operative findings and approaches, and outcomes. RESULTS: All cases (3 male, 2 female) had right-sided hernias. They had clinical features of recurrent chest infections and intermittent vomiting that were present since birth in 3. Three presented acutely ill with findings of respiratory distress and vomiting. Three were referred with misdiagnoses of reflux disease, thoracic mass, and bronchopneumonia. On the chest x-rays of 3 cases, there were paracardiac opacities suggesting a mass lesion. According to the upper gastrointestinal series and/or computed tomography findings, 4 cases had a combination of sliding and paraesophageal hernia, and the remainder one had pure rolling hiatus hernia. Three had obstruction owing to organoaxial volvulus and required an emergency operation. All cases had a large hernia orifice. Four had gastroesophageal junction (GEJ) displaced into the thorax, and in 3, the stomach was found to be twisted, and transverse colon with omentum was also in the thorax in 2. In the remainder, the GEJ was in its normal position with herniated stomach. None of the cases had normal gastrosplenic and gastrocolic ligaments. Surgical repair included resection of the sac, closure of the hiatal defect, and Thal procedure. Two had intestinal malrotation, with right ovarian torsion and ventricular septal defect, respectively. Postoperative ventilation was required in one who later died. At a mean follow-up of 2 years, the other 4 had no symptoms related to the disease, and no evidence of recurrence or reflux was noted on control upper gastrointestinal series. CONCLUSION: Congenital PEHH may be difficult to diagnose. It is frequently complicated and associated with morbidity and even mortality. If the defect is large and associated with displacement of GEJ into the thorax, adding an antireflux procedure to the repair is appropriate. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/16034757/Congenital_paraesophageal_hiatal_hernia:_pitfalls_in_the_diagnosis_and_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022346805002691 DB - PRIME DP - Unbound Medicine ER -