Recidiva paraesofágica de hernia hiatal: diagnóstico radiológico y resolución quirúrgica laparoscópica / Paraesophageal recurrence of hiatal hernia: radiological diagnosis and laparoscopic surgical resolution / Recorrência paraesofágica de hérnia hiatal: diagnóstico radiológico e resolução cirúrgica laparoscópica

La tasa de recidiva radiológica luego de la cirugía de las hernias hiatales grandes tipo IV es cercana al 50%. La mayoría de las veces la recidiva supone un ascenso parcial de la funduplicatura al tórax (telescopaje), y si no tiene expresión clínica puede optarse por un manejo conservador (solo 3-6% requieren cirugía de revisión). Sin embargo, en ocasiones hay otro tipo de recidivas (paraesofágicas) que deben valorarse mediante estudios funcionales, endoscópicos y radiológicos, que dan disfagia con mayor frecuencia. Un tránsito contrastado digestivo superior permite en este caso identificar el tipo de recidiva herniaria, con migración parcial del fundus gástrico hacia el tórax paraesofágico izquierdo, y una funduplicatura continente pero realizada técnicamente en por debajo de lo deseable (cuerpo alto) (figura). La resolución del cuadro implica la reducción de la hernia a la cavidad abdominal, con cierre del defecto diafragmático, desmontar la funduplicatura anterior anatomizando la zona y la reconfección de una nueva funduplicatura.

Cuando no todo es lo que parece_: masa extracardíaca en la aurícula izquierda: reporte de un caso en Uruguay / When not everything is what it seems_: extra-cardiac mass in the left atrium: a case report in Uruguay / Quando nem tudo é o que parece_: massa extracardíaca em átrio esquerdo: relato de um caso no Uruguai

La hernia hiatal es una entidad relativamente frecuente y puede ser un hallazgo incidental en un estudio ecocardiográfico. Describimos el caso de una paciente con diagnóstico de masa en la aurícula izquierda (AI) sin clara etiología, a quien se le realiza el diagnóstico de hernia hiatal por resonancia magnética cardíaca (RMC) y luego se demuestra mediante ecocardiografía de contraste el contenido gástrico de la masa tras la ingestión de una bebida carbonatada, lo que permite de forma rápida y sencilla aclarar el diagnóstico.

Hiatal hernia is a relatively common entity, and may be an incidental finding in an echocardiographic study. We describe the case of a patient with a diagnosis of a mass in the left atrium with no clear etiology, in whom the diagnosis of hiatal hernia is made by cardiac magnetic resonance imaging and then demonstrated by contrast echocardiography the gastric content of the mass after the ingestion of a carbonated drink, which allows quickly and easily to clarify the diagnosis.

A hérnia de hiato é uma entidade relativamente comum, e pode ser um achado incidental em um estudo ecocardiográfico. Descrevemos o caso de um paciente com diagnóstico de massa em átrio esquerdo sem etiologia definida, em que o diagnóstico de hérnia de hiato é feito por ressonância magnética cardíaca e posteriormente demonstrado por ecocardiografia contrastada com uma bebida gaseificada, permitindo esclarecer de forma rápida e fácil o diagnóstico.

Plummer-vinson syndrome associated with lower esophageal ring (Schatzki's Ring)

We report a case of Plummer-Vinson syndrome (PVS) and lower esophageal ring with a small sliding hiatal hernia. PVS is a rare entity formed by the combination of dysphagia, cervical esophageal web and iron deficiency anemia. It occurs mainly in middle-aged women1,2,3. A lower esophageal ring and a small sliding hiatal hernia were also observed in this case. We documented clinical manifestations of iron deficiency anemia through images and esophageal abnormalities through barium esophagogram. (AU)

Abordaje laparoscópico de hernia paraesofágica asistido por robot reporte de un caso / Laparoscopic approach to robot-assisted paraesophageal hernia report of a case

Paciente femenino de 55 años con antecedente de trauma torácico izquierdo con disfagia, disnea, dolor retroesternal y epigástrico, la serie contrastada de esófago estomago duodeno muestra la presencia de hernia paraesofágica que igualmente se corrobora en endoscopia digestiva superior y los estudios tomográficos se plantea la necesidad de la resolución quirúrgica y para ello se realiza abordaje laparoscópico asistido por sistema da Vinci®, se evidencia elongación de pilares del hiato esofágico y desplazamiento a través del fundus gástrico cubierto por peritoneo hacia el tórax izquierdo, se realiza, liberación de los elementos del saco herniario y posterior escisión del mismo, cierre del defecto y reforzado con una banda de politetrafluoroetileno expandido de 5 x 8 cm. Después de la cirugía la paciente se recupera satisfactoriamente inicia dieta a las 24 horas de postoperatorio, la estancia hospitalaria es de 3 días. El abordaje laparoscópico se presenta como una opción que ofrece mayores beneficios al paciente en comparación con el abordaje abierto. Informes sobre corrección de hernia paraesofágica asistida por sistema Da Vinci son limitados y serán tratados en este informe de caso(AU)

Female patient 55 years female with a history of left thoracic trauma with dysphagia, dyspnea, retrosternal and epigastric pain, esophageal contrasted series esophagus stomach duodenum shows the presence of paraesophageal hernia which is also corroborated by upper endoscopy and CT scans raises the need for surgical resolution and it is performed laparoscopic-assisted da Vinci robotic mark, elongation evidenced esophageal hiatus pillars and scrolling through the gastric fundus covered by peritoneum to the left chest, is performed, release of the elements of the sac and subsequent cleavage of the same defect closure and reinforced with a strip of expanded polytetrafluoroethylene 5 x 8 cm. following surgery the patient is recovering diet started at 24 hours after surgery, the hospital stay is 3 days. The laparoscopic approach is presented as an option that provides greater benefits to patients compared with the open approach. Reports paraesophageal hernia correction aided brand da vinci robotic system are limited and will be discussed in this case report(AU)

Congenital para esophageal hernia: A 10 year experience from Saudi Arabia.

Objective. To study the presentation and the outcome of treatment of congenital para esophageal hernias (CPEH) over a period of 10 years from a single tertiary care hospital in Saudi Arabia. Methods. The records of 9 patients presenting between 1997 and 2007, were retrospectively analyzed for demographics, presenting features, referral diagnoses, investigations, management including operative procedures, their outcome and follow-up. Results. Nine patients (3 males and 6 females) aged between 8 days to 34 months were seen. Respiratory distress (n=6), vomiting (n=5) and frequent respiratory tract infections (n=3) were the most common presentations. Cyanosis (n=2), cough and excessive crying were the other important symptoms. The referral diagnoses in these patients included congenital Bochdalek's hernias, lung abscess, bronchogenic cyst, pneumatocoele, bronchiolitis, and pneumonias which reflected a misinterpretation of their clinical findings and chest X-rays. Seven of these patients had other associated congenital anomalies. Three had cardiovascular abnormalities and 2 had lesions of the central nervous system. A pair of siblings had Marfan’s syndrome. All the patients had abnormal chest C-rays and an UGS (upper GI series) proved to be diagnostic in 8 patients. The CT scans done in 4 patients corroborated the findings of the UGS. A laparotomy was done on most patients (n=8) which comprised of reduction of the stomach, resection of the hernial sac, tightening of the hiatus and a gastropexy or a gastrostomy. One patient, who underwent thoracotomy died of surgical complications. Two others died of causes unrelated to the surgery. The remaining six operated patients have been followed up for a median of 3.5 years and are doing well. Conclusion. CPEH is uncommon in children, presents with respiratory tract symptoms and vomiting, and may be associated with Martan syndrome. It should be considered in the workup of a child with vomiting or frequent chest infections. Abnormal chest X-rays may indicate the diagnosis and a subsequent UGS, is confirmatory. The present study found laparotomy a good approach for repair of the wide hiatus. A gastropexy and a floppy fundoplication were added to prevent reherniation and post operative reflux though given the small numbers it is not possible to determine the place of either of these procedures. CPEH may be frequently associated with other congenital problems which may impact survival.

Hernia hiatal mixta. Reporte de un caso / Mixed hiatal hernia. A case report

Se presenta una paciente en la sexta década de la vida, con sintomatología digestiva alta de 4 años de evolución, caracterizada por epigastralgia, acidez y vómitos que no resuelve con tratamiento médico y a la cual se le realiza un estudio radiográfico contrastado de esófago, estómago y duodeno, donde se diagnostica una hernia hiatal mixta, la cual se interviene por vía abdominal y se le realiza cierre del pilar derecho del hiato esofágico y funduplicatura tipo Nissen I, con lo cual se le cura definitivamente. Por la magnitud y lo infrecuente de esta variedad de hernia hiatal, la consideramos de interés para la literatura médica(AU)

The case of a female patient at her sixth decade of life with high digestive symptomatology of 4 years of evolution, characterized by epigastralgia, acidity and vomits, is presented. As the patient did not resolve with medical treatment, she underwent a radiological contrast study of the esophagus, stomach and duodenum, where a mixed hiatal hernia was diagnosed. She was operated on through the abdomen. Closing of the right pillar of the esophageal hiatus and Nissen I type fundoplication, with which she was definitely cured, were performed. Taking into account the magnitude and uncommonness of this variety of hiatal hernia, we consider it is of interest for medical literature(AU)

Ultrasonographic signs of sliding gastric hiatal hernia and their prospective evaluation

This study was conducted to identify sonographic findings that might be used in diagnosing sliding gastric hiatal hernia [SGHH] by using transabdominal ultrasound [TUS], to measure normal length and thickness of abdominal esophageal walls and to identify esophagogastric junction [OGJ]. A retrospective evaluation of 18 patients known to have sliding hiatal hernia and 12 normal controls was performed. A prospective study of 38 patients with symptoms suggesting hiatal herniation [epigastric or chest pain, heart burn and regurgitation] had been evaluated. In the controls, the OGJ could be visualized clearly in all cases and alimentary tract section [ATS] at the diaphragmatic hiatus ranged from 7.1 to 10.0 mm. The OGJ was not visualized in any of hernia patients whose alimentary tract diameters ranged from 16.0 to 21.0 mm. The use of US in the initial workup of patients with symptoms suggesting hiatus hernia may reduce the need for more invasive diagnostic procedures

Epiphrenic diverticulum of the oesophagus.

A case of asymptomatic, large, epiphrenic diverticulum of oesophagus associated with sliding hiatus hernia and gall stones is reported.