Abstract
A 57-year-old woman presented to the emergency department because of the sudden onset of severe epigastric pain. She was pointed out having esophageal hernia by medical checkup five years previously, and had complained of mild postprandial distress. Abdominal CT scan revealed that the stomach including the esopagogastric junction and pyloric ring, and a part of the transverse colon were located in the mediastinum, but a part of the gastric wall retrogradely herniated to the abdominal cavity through the esophageal hiatus and was strangulated. One hour after her visit, the severe pain disappeared, when a thoracoabdominal CT scan with contrast medium also showed type IV esophageal hiatal hernia with the stomach and the transverse colon, but the retrograde herniation of the part of the stomach was dissolved. We speculated that the retrograde herniation might cause the severe abdominal pain. We performed laparoscopic repair electively because the severe pain had been relieved. Laparoscopically, we found a type IV esophageal hernia. The herniated stomach and colon were easily reduced into the abdomen and the hernia sac was resected. The hiatal hernia defect was closed by primary suture of the diaphragmatic crus and was reinforced by mesh placement. Nissen fundoplication was added. The patient is doing well without any recurrence of hiatal hernia, as of 10 months after the operation.
