Abstract
A 67-year-old woman suffered postprandial chest and back pain. Because gastrography revealed a saccular gastric protrusion above the diaphragm, her gastroenterologist made a diagnosis of paraesophageal hiatal hernia. After admission to the surgical department, she underwent esophageal manometry and 24-hr pH and bilirubin monitoring for evaluation of gastroesophageal reflux disease (GERD); however, these examinations did not indicate GERD. Close evaluation of the computed tomography findings disclosed a left diaphragmatic crus between the abdominal esophagus and the herniated stomach; therefore, we made a diagnosis of parahiatal hernia. The operation was performed laparoscopically, the hernia content (gastric fundus) was reduced into the abdominal cavity, and the orifice was sutured. Because parahiatal hernia mimics paraesophageal hiatal hernia in clinical findings and diagnostic images, it is usually not correctly diagnosed preoperatively, only by the intraoperative findings. Paraesophageal hiatal hernia results from defects of the tissue around the gastroesophageal junction, but on the other hand, parahiatal hernia originates from embryological weakness of the diaphragm. Paraesophageal hiatal hernia frequently needs fundoplication but parahiatal hernia does not; therefore, these two hernias should be distinguished before operation.
