A Case of Bile Duct Obstruction associated with an Incarcerated Paraesophageal Hernia of the Head of Pancreas

Abstract

A 71-year-old woman admitted for gastric ulcer, pyloric stenosis, and severe anemia was found in upper gastrointestinal X-ray to have prolapse of the gastric antrum and duodenum into the mediastinum. Abdominal computed tomography (CT) showed the pancreatic head to have herniated into the mediastinum. Her symptoms were temporary relieved by gastrointestinal endoscopy. But liver dysfunction developed, drip infusion cholangiography (DIC)-CT showing bile duct dilation. Under a diagnosis of bile duct obstruction and intractable ulcer due to incarceration of the gastric antrum, duodenum, and pancreatic head of pancreas, we closed the hernia defect after determining that a portion from the gastric antrum to the second portion of the duodenum with the pancreatic head of pancreas was incarcerated in the paraesophageal hiatus. The woman was discharged 12 days after surgery and had no recurrent symptoms in the 30 months after surgery.