Abstract
BackgroundHiatal hernias are common. In some reports, hiatal hernias have been implicated in causing dyspnea, syncope, and heart failure.Case presentationAn 82-year-old woman with a hiatal hernia was admitted to our hospital because she had experienced postprandial syncope during the last few years. Esophagogastroduodenoscopy revealed a large hiatal hernia and a pedunculated polyp of the stomach antrum that fit into the pylorus. An upper gastrointestinal contrast study showed that the entire stomach had relocated to the thoracic cavity and that the body of the stomach was located above the fundus, resulting in a so-called upside-down stomach. Contrast-enhanced computed tomography revealed that a large portion of the stomach, transverse colon, and part of the pancreas were present in the mediastinum. We then performed transthoracic echocardiography followed by a water pouring test using a nasogastric tube. After instillation of 2000 ml of saline, the left atrium was markedly compressed and the area of the mitral annulus was reduced. We determined that stomach dilation by the hiatal hernia and gastric polyp had caused the syncope. The patient underwent laparoscopic hiatal hernia repair and endoscopic gastric polypectomy, and she experienced no syncopal episodes for 5 months postoperatively.ConclusionsClinicians should recognize that a large hiatal hernia may be a risk factor for syncope.
Highlights
Clinicians should recognize that a large hiatal hernia may be a risk factor for syncope
The postoperative course was good, and the patient was discharged uneventfully. She experienced no syncopal episodes for 5 months postoperatively. The patient in this case developed syncope due to heart failure caused by a giant hiatal hernia
We found that content of hiatal hernia was the cause of the decreased cardiac output
Summary
Hiatal hernias in adults often develop in elderly people, and the main symptoms are heartburn, chest pain, reflux, and dysphagia. Few reports have mentioned heart failure-induced syncope in patients with giant hiatal hernias [3,4,5,6,7,8,9,10]. No reports have described a syncopal episode caused by a hiatal hernia and prolapsing gastric polyp. Case presentation An 82-year-old woman with a hiatal hernia was admitted to our hospital for a detailed examination She reported repeated postprandial syncope once a year, and the frequency had increased in recent years. The hernia orifice was sutured closed after reduction of the hernia contents Because this patient showed no evidence of reflux esophagitis, fundoplication was not performed.
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