Incarcerated Giant Hiatal Hernia conditioning hearth shock: case report

Medina Andrade Luis Angel*, Cesar Manuel Vargas Sahagún, Carlos Eduardo Rodriguez Rodriguez, Pedro Leonardo Villanueva Solorzano, Alberto Robles Méndez Hernández, Bernardo Gutierrez Muñoz, Valdez Hernandez Brenda Elizabeth, Brigitte Marlene Chevillon Castillo, Vallejo Ramirez Jose Eduardo, Campos Cruz Alan Ranferi and Tolentino Gonzalez Christian Stefan

Between the hiatal hernias, the type IV is the less frequent by the great defect, but this type had a high incidence of incarceration (5%), and a mortality rate up to 27%. Case: A female patient of 80 years-old was referred to our hospital by septic shock and abdominal

pain. At physical exam she refers abdominal and thoracic pain, dyspnea and occasional threw up for the

last 2 days, with a background of this symptoms the last 5 years, and gastroesophageal refl ux symptoms

for 10 years. At admission, she referred epigastric and retrosternal pain, dyspnea, with an 02 of 75%, bowel

sounds in left hemithorax, mean arterial pressure of 50mmHg with the use of norepinephrine. Laboratories

do not reveal sepsis and CT scan reports a hiatal hernia of 9 cm with left hemithorax occupied by stomach,

colon, and spleen. A cardiogenic shock by compression was suspected with this data and a laparotomy

was scheduled. CT scan report was confi rmed and the mentioned organs were reduced to abdomen

without problems, both diaphragmatic pillars were sutured and a Nissen fundoplication completed. After

6 hours’ norepinephrine was suspended and 48 hours after the patient were discharged uneventfully.

Conclusion: Giant hiatal hernia must be suspected in patients with chronic abdominal and thoracic

pain with refl ux symptoms because the complications associated with this disease could have a mortality

near 30% in case of strangulation and a scheduled surgery could be very safe in the correct moment.

Keywords:

Published on: Mar 14, 2018 Pages: 12-14

Full Text PDF Full Text HTML DOI: 10.17352/2455-2283.000049
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