Hiatal Hernia and Short Oesophagus in Children

Abstract

Diseases and malformations of the oesophagus have hitherto been a neglected field in paediatrics. During recent years this attitude has been altered, because the progress of thoracic surgery has made operations on the oesophagus a much safer procedure and has thus increased the possibility of treating surgically oesophageal lesions in children. Among the diseases and malformations which have become the object of renewed interest is congenital hiatal hernia coexisting with a shortening of the oesophagus, which Scandinavian and French workers are accustomed to call " brachyoesophagus." PREVioUS REPORTS A review of about 70 cases reported up to 1947 can be found in a paper published by one of us (Thomsen, 1949). In addition to several single cases, two large series were published in 1948, one from England and one from America, Allison reporting seven cases and'Olsen and Harrington eight among children. Considering that the condition has been known for almost 30 years, the number of published cases, about 100, is not impressive, and, judging by the literature, short oesophagus would appear to be rare among children. It would seem, however, that the literature does not convey the proper impression, since we have been able to collect 24 cases diagnosed within the last decade, 14 of them since 1947. AETIOLOGY As stated in the previous paper (Wamberg, 1947) some disagreement has existed as to the aetiology. According to Bund a persistence of the right pneumato-enteric recess produces a hernia in which the stomach forms the hernial contents. Tondorff, on the other hand, claims that the caudal shift of the diaphragm and abdominal contents, which normally takes place in the fourth to fifth foetal week, is disturbed so that the longitudinal growth of the oesophagus ceases and a major or minor portion of the stomach remains in the thoracic cavity, whereas the diaphragm, completing its caudal movement, envelops the thoracic stomach in a thin layer of connective tissue. Recent papers, particularly from England (Allison, 1948), have shown that none of these theories can be accepted. The fact that short oesophagus and peptic ulcer of the oesophagus are met with in a comparatively large number of subjects over 50 years of age with no history of dyspeptic symptoms militates against the idea of a congenital defect. In 1926 Akerlund described a form of hiatal hernia, occurring particularly among elderly individuals, in which the hernial

Hiatus Hernia in Infancy

“…Allison's theory [2, 31 was confirmed in a study by Husfeldt et al [9]. This includes a total of 24 patients with hiatus hernia and secondary shortening of the oesopaghus.…”

Findings on Barium Swallow in Younger Siblings of Children with Hiatal Hernia (Partial Thoracic Stomach)

“…12, No. 2,1991 was 63% (17/27) in those with positive symptoms, 23.5% (8/34) in those with equivocal symptoms, and 4.3% (9/210) in those without symptoms. If the two symptomatic groups are combined, the incidence of HH in symptomatic siblings was 41% (25/61).…”

“…In the period between 1950 and 1960, a number of articles in the European literature drew attention to the importance of a hiatal hernia (HH) [or partial thoracic stomach (l )-the term we prefer] as a cause of persistent vomiting in children (2)(3)(4) . An assessment of the natural history of patients with HH attending hospital showed that about one-third could be expected to suffer from troublesome symptoms to beyond 4 years of age with about 10% of these latter patients developing an esophageal stricture (5).…”

A 20‐Year Follow‐up of Children with a Partial Thoracic Stomach (Hiatal Hernia)*

“…Not until the one with which we are solely concerned in the earl!-10c50s did reports from Europe apprar this review. In lhis form, the oesophago-gastric indicating that the condition was in fact much commoner in children than had been supposed (Husfeldt et al, 1951;Carre et al, 1952;Roviralta, 1952). This prediction has since been confirmed with the publication of numerous reports on the subject, though interesting variations in incidence have been reported from different countries, notably from the U.S.A., where the condition has been observed relatively infrequently (Guttman, 1972).…”