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Hiatal hernias occur when intra-abdominal contents protrude into the diaphragmatic opening. Of the four classifications, Type 4 hiatal hernias are the most rare and severe. They develop from herniation of the gastroesophageal junction and abdominal viscera other than the stomach into the thoracic cavity. The resulting increase in intrathoracic pressure can cause a wide variety of symptoms on presentation and potentially lead to misdiagnosis. We present a rare case in which a 78-year-old woman presented with nonspecific symptoms and was diagnosed with incarcerated Type 4 hiatal hernia with sigmoid volvulus. We also report a literature review from 2015 to emphasize the importance of recognizing diverse symptomatic presentations in complex Type 4 hiatal hernias and the need for a comprehensive evaluation, as early detection and prompt intervention are essential in preventing life-threatening complications.
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http://dx.doi.org/10.7759/cureus.63595 | DOI Listing |
Cureus
July 2025
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND.
A 65-year-old male presented with abdominal pain and swelling persisting for five years. On clinical examination, a 15 cm transverse scar was noted above the umbilicus, along with a reducible incisional hernia. Contrast-enhanced CT of the abdomen revealed an incisional hernia with a single defect at the umbilical and epigastric regions with European Hernia Society classification of M2-3, W3, along with a rolling-type paraesophageal hernia.
View Article and Find Full Text PDFJ Pediatr Surg
August 2025
Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
Aim: Evidence for the management of large hiatus herniae (HH) in children is lacking. Adult literature is conflicting with regard to risk vs. benefit profile of prosthetic mesh use; rates of dysphagia or recurrence are up to 25 % and 38 %, respectively.
View Article and Find Full Text PDFCureus
August 2025
Gastroenterology, Boonshoft School of Medicine, Wright State University, Dayton, USA.
Hiatal hernia (HH) is defined as the protrusion of abdominal contents through the esophageal hiatus of the diaphragm into the mediastinum. They are classified into categories I-IV. Type I, known as the sliding hernia, accounts for up to 90% of HH cases and are typically managed medically.
View Article and Find Full Text PDFTherap Adv Gastroenterol
August 2025
Department of Thoracic Surgery and Lung Transplantation, First Affiliated Hospital of Zhengzhou University, No. 1 Jian She Road, Zhengzhou, Henan Province 450052, China.
In recent years, common postoperative complications after esophagectomy have received increasing attention. However, the attention paid to rare complications, which often lead to serious consequences if they are not diagnosed in a timely manner, has not been sufficient. In this article, we present both the clinical and imaging features of rare complications following esophagectomy and strategies for their prevention and management.
View Article and Find Full Text PDFCureus
July 2025
Department of Surgery, New York-Presbyterian Queens, New York, USA.
Sleeve gastrectomy is currently the most common bariatric procedure in the United States, with over 750,000 cases performed between 2018 and 2022. While early complications such as hemorrhage and leaks are well documented, increasing data reveal a broader range of long-term complications, including stricture, gastroesophageal reflux, and hernias. We present a rare case of gastric sleeve herniation through a hiatal hernia (HH), resulting in gastric obstruction, a phenomenon not previously documented in the literature.
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