Abstract
An 84-year-old woman was admitted to our hospital because of vomiting and epigastralgia. Chest radiograph and computed tomography with contrast imaging showed a complicated esophageal hiatal hernia (type IV) involving with the entire stomach, small intestine, and transverse colon in the left side of the pleural cavity. Because the contrast medium was not detected in the small intestine, we performed emergent surgery on the esophageal hiatus hernia because a strangulated ileus was suspected.
Intraoperatively, we found an internal hernia of the mesocolon of the transverse colon in addition to the esophageal hiatal hernia. The internal hernia involved the strangulated jejunum. We resected the necrotizing jejunum. We returned the contents of the esophageal hiatus hernia into the abdominal cavity and repaired the hiatal gate using a mesh-free suture. However, the gastroesophageal reflex persisted and the patient was discharged on the 10th postoperative day. Here we described a rare case of esophageal hiatus hernia complicated by an internal hernia and strangulated jejunum.
