Omental hiatus hernia is a relatively rare entity of all intraabdominal hernias. This time we experienced an extremely rare case of the disease associated with hiatus herina of the esophagus.
An 82-year-old woman was seen at the hospital because of upper abdominal pain, and was admitted with a diagnosis of intestinal obstruction. A fluoroscopic study through a long intestinal tube revealed the incarcerated jejunum in a hiatus hernia of the esophagus. The patient was operated on. Upon laparotomy, the jejunum which prolapsed from an omental hiatus hernia along with the fundus of the stomach were incarcerated in the hiatus hernia of the esophagus. No intestinal necrosis was noted, and so a closure of the omental hernia, plication sutures for the esophageal hernia, and posterior fixation of the gastric fundus were performed.
In treating intestinal obstruction in elderly patients without previous history of laparotomy, if malignant diseases can be ruled out and conservative treatments are ineffective, laparotomy is a consideration by entertaining a possibility of internal hernia.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)