Massive hiatus hernia complicated by jaundice

Abstract

Giant para-oesophageal hernia may include pancreas with pancreatic complication and rarely jaundice. Repair is feasible and durable by laparoscopy. Magnetic resonance cholangiopancreatography is diagnostic.

Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature

“…Pancreatic herniation may occur in patients with many different kinds of hiatal hernia. They have been reported in congenital [11,15,18] and acquired hernias [3,4,6,10,12,14,16,19,20], but also as rare longterm complication after both transhiatal and transthoracic esophagectomy [8,9]. Even isolated (possibly congenital) herniation of just the pancreas [2] and transient pancreatic herniation have been reported [6,14].…”

“…In the last 25 years, 17 cases of intrathoracic herniation of (parts of) the pancreas have been reported ( [4,10,11,[16][17][18][19], vomiting [17,18], dysphagia [4] or dyspnea [2,16,20]. Five cases, however, were diagnosed with pancreatitis secondary to intrathoracic pancreatic herniation [3,6,[13][14][15], one of which was associated with pancreatic torsion [6].…”

Cholangiocarcinoma obscured by a large paraesophageal hernia causing traction compression of the common hepatic duct ultimately diagnosed with percutaneous cholangioscopy

“…Biliary decompression is best attempted via percutaneous drainage because ERCP is less likely to be successful owing to the challenging anatomy. 1,[3][4][5] However, surgery may need to be performed urgently if there is concern for bowel ischemia owing to strangulation inside the hiatal hernia. 5 We present the first case of a coexisting cholangiocarcinoma, complicating a very rare manifestation of type IV hiatal hernia.…”

“…Obstructive jaundice due to abrupt tapering of the common bile duct at the hiatus of a type IV hiatal hernia is extremely rare. 1 , 2 , 3 , 4 , 5 Definitive management requires surgical repair of the hiatal hernia 1 and is undertaken after decompression of the biliary obstruction. Biliary decompression is best attempted via percutaneous drainage because ERCP is less likely to be successful owing to the challenging anatomy.…”

“…Biliary decompression is best attempted via percutaneous drainage because ERCP is less likely to be successful owing to the challenging anatomy. 1 , 3 , 4 , 5 However, surgery may need to be performed urgently if there is concern for bowel ischemia owing to strangulation inside the hiatal hernia. 5 …”