Rare sequalae of hiatal hernia causing pancreatitis and hepatitis: A case report

Abstract

BACKGROUNDHiatal hernia (HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.CASE SUMMARY79-year-old female with multiple comorbidities presented to emergency department with complaints of weight loss for 6 mo and abdominal pain for one day. Physical examination revealed cachectic and dehydrated female and bowel sounds could be auscultated on the right side of chest. Computed tomography of the chest and abdomen revealed interval enlargement of a massive HH, containing stomach and much of the bowel as well as pancreas and distal extra-hepatic biliary duct, probably responsible for obstructive effect upon same. There was increased prominence of the pancreas consistent with pancreatitis. There was a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. Patient clinical status improved with conservative treatment.CONCLUSIONHH presenting with acute pancreatitis is a serious diagnostic and therapeutic challenge. The initial management is conservative, even if the abdominal content has herniated to mediastinum. The incentive spirometry can be utilized in the conservative of the large HH. After stabilization of the patient, elective surgical intervention remains the mainstay of the management. Definitive treatment will vary from case to case depending on the acuity of situation and comorbidities.

Massive hiatal hernia involving prolapse of the entire stomach and pancreas resulting in pancreatitis and bile duct dilatation: a case report

“…Herniation of pancreas can be without symptoms and found accidentally on imaging or as a sequel to acute pancreatitis. Acute pancreatitis as a sequela of this mechanism is very rare and has been previously reported in 13 patients [13][14][15][16][17][18][19][20][21][22][23][24][25]. Table 1 lists acute pancreatitis caused by the herniation of pancreas in HH from previous reports.…”

Diaphragmatic hernia a rare cause of acute pancreatitis: Case report

“…Because the head segment of the pancreas and duodenum are positioned in the retroperitoneum and held by Treitz' ligament, pancreatic herniation is extremely rare [3] . However, stretching of the transverse mesocolon due to increased intra-abdominal pressure induces posterior fascia loosening, leading in pancreatic mobility, and herniation [2] . Pancreatic herniation is a rare occurrence, with just 12 cases reported to date [3] .…”

“…Post-traumatic diaphragmatic hernia is described as the permanent or intermittent prolapse of any abdominal structure into the mediastinum or thoracic cavity via the diaphragm apertures [1] . In the sixteenth century, Ambroise Pare reported this disease for the first time [2] . The stomach is the most commonly herniated organ.…”

Pancreatitis aguda necrosante secundaria a hernia de hiato grado IV complicada: Presentación de un caso y revisión de la literatura

“…En la mayoría de estos, es el cuerpo y la cola los que migran a través del diafragma, siendo la herniación de la cabeza pancreática un proceso extremadamente raro. Una revisión sistemática de los casos de páncreas herniados a través del hiato esofágico reportados desde 1958 hasta 2020, identifica tan solo 17 pacientes diagnosticados de pancreatitis aguda secundaria a hernias paraesofágicas tipo IV [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] (Tabla 1).…”