SCIENTIFIC
Rare Presentation of a Type IV Hiatal Hernia Involving the Neck of the Pancreas
AUTHORS : Anthony Chen , BA
Ankur Makani , MD Shane W . Monnett , DO , FACS Richmond K . Bryan , MD
Department of General Surgery , West Virginia University School of Medicine , Charleston , WV
CORRESPONDING AUTHOR : Anthony Chen , BA Ac00015 @ mix . wvu . edu
ABSTRACT
A 77-year-old woman with a long-standing hiatal hernia presented to the emergency department with complaints of epigastric abdominal pain and shortness of breath . Abdominal computed tomography revealed a large diaphragmatic hernia containing portions of the stomach , transverse colon , pancreas , and
FIGURE 1
abdominal fat . Intraoperatively , the entire stomach , half of the transverse colon , the splenic flexure , the pancreas neck , and a portion of the pancreas body were intrathoracic , which is an extremely unusual finding . We describe this rare case of the herniation of the neck of the pancreas into the thoracic cavity .
DISCLOSURES : None
ETHICS STATEMENT : Permission obtained from patient
FUNDING : None
CASE PRESENTATION
A 77-year-old woman with a nine-year history of a hiatal hernia presented to the emergency department with symptoms of shortness of breath and epigastric abdominal pain . The patient explained that for the past 9 years , she had experienced pressure-like pain radiating from the epigastric region to the right side of her chest . She denied any precipitating or alleviating factors , nausea or vomiting , changes in bowel movements , or any other associated concerns or complaints . Past medical history included hypertension and hypothyroidism . She had no prior surgical history , and her family history and social history were non-contributory . On physical examination , the patient appeared well and in no apparent distress with normal vital signs . Abdomen was soft and nondistended with bowel sounds present in all four quadrants ; mild epigastric pain was elicited upon palpation . Chest expansion was noted to be equal bilaterally with non-labored breathing and clear lung sounds to auscultation bilaterally .
CT axial view revealing a Type IV hiatal hernia containing much of the stomach as well as portions of the pancreas ( arrow ), transverse colon ( asterisk ), and abdominal fat .
FIGURE 2
CT coronal view revealing a Type IV hiatal hernia containing much of the stomach as well as portions of the pancreas ( arrow ), transverse colon ( asterisk ), and abdominal fat ; H is indicating the heart .
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