A Case of Type Ⅳ Hiatal Hernia with Severe Sliding and Adhesion Leading to Heart Failure

Abstract

An 83-year-old man presented to our hospital with the chief complaint of breathlessness and generalized edema. Computed tomography revealed a type Ⅳ hiatal hernia, with an upside-down stomach and herniation of the duodenum, transverse colon, small intestine, and pancreatic body. The hernia contents caused severe heart failure due to compression of the heart. Since conservative management was successful, elective laparoscopy-assisted hiatal hernia repair was performed. Although the esophagus and stomach had slid deep into and were tightly adherent to the hernia sac, we reduced them carefully under laparoscopic guidance. However, reduction of the pancreas proved so difficult that we had to convert the surgery to open laparotomy to avoid the risk of pancreatic injury and hernia recurrence. Although this was a case of type Ⅳ hiatal hernia with severe sliding and adhesion that needed laparotomy, it was possible to avoid thoracic surgery because of the laparoscopic visual field in the sac, and we obtained a good postoperative course.