Abstract
Congenital hiatal hernia (CHH) in children is a very rare condition that occurs in about 1 in every 2,000 to 5,000 live births, with a male to female ratio of 2:3. In 97% of cases the anomaly is unilateral with a left side preponderance. The hernia content can include the stomach, bowel loops, spleen or part of the liver [1–4]. CHH may remain asymptomatic or induce only nonspecific gastrointestinal and/or thoracic symptoms [1–6]. 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, 5, 6]. Because of the gastroesophageal reflux, linear ulcerations on the esophageal mucosa might occur and cause intermittent bleeding. Plain chest radiographs, AP and lateral, may raise a suspicion of the condition, while upper gastrointestinal contrast series are diagnostic [5–7]. The treatment is surgery 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, 5]. If the defect is large and associated with displacement of the gastroesophageal junction (GEJ) into the thorax, adding an anti-reflux procedure to the repair is appropriate [7]. This can be achieved transabdominally either by laparotomy or laparoscopically [5–7]. To the best of our knowledge, this is the second case diagnosed with Meckel’s scintigraphy[8] (Figs. 1 and and22). Fig. 1 A 3-year-old girl who complained of stiff and black-colored stool with monthly periods was referred to our clinic for Meckel’s scintigraphy during a search for causes of iron deficiency anemia. She had no history of trauma, and her physical examination ... Fig. 2 Plain chest X-ray, AP and lateral views, revealed a radiolucent shadow (arrows) in the right posterior mediastinum. The patient underwent successful correctional surgery
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