Archive | 2019
Incarcerated Paraesophageal Hernia: Incidence, Presentation, and Initial Management
Abstract
Hiatal hernias are common and often asymptomatic. Their etiology is multifactorial and related to chronically elevated intra-abdominal pressure. Advanced paraesophageal hernias are rare and may be complicated by incarceration or gastric volvulus with subsequent ischemic necrosis and perforation if not recognized and treated promptly. This may be difficult as initial presenting symptoms are often vague and may rapidly progress to cardiovascular collapse or sepsis and respiratory failure. They may also be complicated by gastrointestinal hemorrhage from Cameron lesions, which often presents as overt bleeding. Initial management of incarceration or volvulus is resuscitation and rapid gastric decompression. If necrosis or perforation is suspected, antibiotics are administered. Bleeding is temporized initially with acid suppression, resuscitation, and endoscopic therapies. Definitive management of complicated paraesophageal hernia is surgical.