Hiatus Hernia

• Cause is unknown, may be congenital or acquired
• This is a sack like dilation of the stomach with protrusion above the diaphragm
• There is separation of the diaphragmatic crura and widening of the oesophageal foramen
• There are two types of hernia;
  • Sliding or axial hernia
    • 95% of cases
    • Protrusion of the stomach above the diaphragm creates a bell shaped dilation
  • Rolling hernia or paraoesophageal hernia
    • Less than 5% of cases
    • Cardia of the stomach dissects into the thorax adjacent to the oesophagus
    • This is part is vulnerable to strangulation and infarction

 

Clinical

• Occur in 1-20% of adults with incidence increasing with age
• Around 9% have symptoms – gastric reflux and retrosternal chest pain
• Complications;
  • Both types can bleed and perforate
  • Paraoesophageal hernias can become strangulated and obstructed