Abstract
BackgroundParaesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ. The hereby reported combination of an incarcerated paraesophageal hernia containing a perforated peptic ulcer is extremely rare.Case presentationAn elderly man with multiple medical conditions was admitted due to severe upper abdominal pain. The patient was found to have a paraesophageal hernia and underwent a laparotomy. In the hernia, a perforated benign peptic duodenal ulcer was found. The duodenal defect was over-sewn, the hernial defect was closed and the former hernial cavity was drained by a right-sided chest tube. The patient was discharged one month after surgery and was found to do well at follow-up one month after discharge.ConclusionThis is the first report of a patient surviving the extremely rare and life-threatening combination of a perforated peptic duodenal ulcer in a paraesophageal hernia.
Highlights
Paraesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ
This is the first report of a patient surviving the extremely rare and life-threatening combination of a perforated peptic duodenal ulcer in a paraesophageal hernia
Since paraesophageal hernias present in adult life in the majority of cases, acquired causes such as mechanical forces and tissue degeneration are probable etiological factors, albeit congenital factors cannot be ruled out since paraesophageal hernias and its complications exist in the pediatric literature [1-5]
Summary
The distinction between a sliding hiatal hernia and a paraesophageal hernia is based on whether the esophagogastric junction (cardia) is above (sliding hernia or type I hiatal hernia) or below (paraesophageal hernia) the diaphragm. A CT scan of thorax and abdomen showed a paraesophageal herniation into the right thorax containing a part of the transverse colon and a part of the distal stomach and proximal duodenum. A perforated peptic ulcer exposes the patient to a considerable risk of dying in patients above seventy years of age. We hereby report a case with the extremely rare combination of perforated peptic duodenal ulcer in a paraesophageal herniation with, for the first time in the literature, successful outcome. This 88-year-old man had several serious medical conditions: angina pectoris, chronic obstructive pulmonary dis-.
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