Hiatus hernia
Updates to Article Attributes
Hiatus herniahernias occurs where there (HH) occur when there is herniation of stomach It
Clinical presentation
Many patients with HH are asymptomatic and it is sometimes wronglyan incidental finding. However, symptoms may include epigastric/chest pain, post prandial fullness, nausea and vomiting 3.
Sometimes HH are considered synonymous with gastro-oesophageal reflux disease (GORD) despitebut there is a poor correlation between the two conditions.
Sub typesPathology
ThereThe most common contents of a HH is the stomach. There are two main types of hiatus hernia, although they may co-exist:
Subtypes
Sliding hiatus hernia
This is the most common type of hiatus hernia (95%). The gastro-oesophageal junction (GOJ) is usually displaced by more than 2 cm above the hiatus. The oesophageal hiatus is often abnormally widened to 3-4 cm (the upper limit of normal is 15 mm).
The gastric fundus may also be displaced above the diaphragm and present as a retrocardiac mass on a chest radiograph. The presence of an air-fluid level in the mass suggests the diagnosis.
Small, sliding hiatus hernias commonly reduce in the upright position. The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower oesophageal sphincter and the presence of pathologic gastro-oesophageal reflux are the crucial factors in producing symptoms and causing complications.
Rolling (para-oesophageal) hiatus hernia
The rolling (paraesophageal(para-oesophageal) hiatus hernia is much less common than the sliding type. The GOJ remains in its normal location while a portion of the stomach herniates above the diaphragm.
The mixed or compound hiatal hernia is the most commonest type of paraesophagealpara-oesophageal hernia. The GOJ is displaced into the thorax with a large portion of the stomach, which is usually abnormally rotated. In these hernias where large portions of the
Complications
HH containing stomach may be contained within the thoracic cavity, there are significant risks forresult in gastric volvulus, which in turn presents as intestinal obstruction, and ischemiamay result in ischaemia/infarction.
Radiographic features
Plain radiograph
- retrocardiac opacity with air-fluid level
Differential diagnosis
On a plain film (PA/AP Chestfrontal chest radiograph) consider:
- retrocardiaclung abscess
- retrocardiac empyema
- epiphrenic oesophageal diverticulum
See also
-<p><strong>Hiatus hernia</strong> occurs where there is herniation of <a href="/articles/stomach">stomach </a>through the <a href="/articles/oesophageal-hiatus">oesophageal hiatus</a> of the <a href="/articles/diaphragm">diaphragm</a>. It is sometimes wrongly considered synonymous with <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a> despite poor correlation between the two.</p><h4>Sub types</h4><p>There are two main types of hiatus hernia, although they may co-exist:</p><ul>-<li><a href="/articles/sliding-hiatus-hernia">sliding hiatus hernia</a></li>-<li><a href="/articles/rolling-para-oesophageal-hiatus-hernia">rolling (para-oesophageal) hiatus hernia</a></li>-</ul><h5>Sliding hiatus hernia</h5><p>This is the most common type of hiatus hernia (95%). The <a href="/articles/gastro-oesophageal-junction">gastro-oesophageal junction</a> (GOJ) is usually displaced by more than 2 cm above the hiatus. The oesophageal hiatus is often abnormally widened to 3-4 cm (the upper limit of normal is 15 mm).</p><p>The gastric fundus may also be displaced above the <a href="/articles/diaphragm">diaphragm</a> and present as a <a href="/articles/retrocardiac-mass">retrocardiac mass</a> on a chest radiograph. The presence of an air-fluid level in the mass suggests the diagnosis.</p><p>Small, sliding hiatus hernias commonly reduce in the upright position. The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower oesophageal sphincter and the presence of pathologic gastro-oesophageal reflux are the crucial factors in producing symptoms and causing complications.</p><h5>Rolling (para-oesophageal) hiatus hernia</h5><p>The rolling (paraesophageal) hiatus hernia is much less common than the sliding type. The GOJ remains in its normal location while a portion of the stomach herniates above the diaphragm.</p><p>The mixed or compound hiatal hernia is the most commonest type of paraesophageal hernia. The GOJ is displaced into the thorax with a large portion of the stomach, which is usually abnormally rotated. In these hernias where large portions of the stomach may be contained within the thoracic cavity, there are significant risks for <a href="/articles/gastric-volvulus">volvulus</a>, obstruction, and ischemia.</p><h4>Differential diagnosis</h4><p>On a plain film (PA/AP Chest radiograph) consider:</p><ul>-<li>retrocardiac<a href="/articles/lung-abscess"> lung abscess</a>- +<p><strong>Hiatus hernias</strong> (<strong>HH</strong>) occur when there is herniation abdominal contents through the <a href="/articles/oesophageal-hiatus">oesophageal hiatus</a> of the <a href="/articles/diaphragm">diaphragm</a> into the thoracic cavity.</p><h4>Clinical presentation</h4><p>Many patients with HH are asymptomatic and it is an incidental finding. However, symptoms may include epigastric/chest pain, post prandial fullness, nausea and vomiting <sup>3</sup>. </p><p>Sometimes HH are considered synonymous with <a href="/articles/gastro-oesophageal-reflux-disease">gastro-oesophageal reflux disease (GORD)</a> but there is a poor correlation between the two conditions.</p><h4>Pathology</h4><p>The most common contents of a HH is the <a href="/articles/stomach">stomach</a>. There are two main types of hiatus hernia, although they may co-exist:</p><ul>
- +<li>
- +<a href="/articles/sliding-hiatus-hernia">sliding hiatus hernia</a> (~90%)</li>
- +<li>
- +<a href="/articles/rolling-para-oesophageal-hiatus-hernia">rolling (para-oesophageal) hiatus hernia</a> (~10%)</li>
- +</ul><h5>Subtypes</h5><h6>Sliding hiatus hernia</h6><p>This is the most common type of hiatus hernia (95%). The <a href="/articles/gastro-oesophageal-junction">gastro-oesophageal junction</a> (GOJ) is usually displaced by more than 2 cm above the hiatus. The oesophageal hiatus is often abnormally widened to 3-4 cm (the upper limit of normal is 15 mm).</p><p>The gastric fundus may also be displaced above the <a href="/articles/diaphragm">diaphragm</a> and present as a <a href="/articles/retrocardiac-mass">retrocardiac mass</a> on a chest radiograph. The presence of an air-fluid level in the mass suggests the diagnosis.</p><p>Small, sliding hiatus hernias commonly reduce in the upright position. The mere presence of a sliding hiatus hernia is of limited clinical significance in most cases. The function of the lower oesophageal sphincter and the presence of pathologic gastro-oesophageal reflux are the crucial factors in producing symptoms and causing complications.</p><h6>Rolling (para-oesophageal) hiatus hernia</h6><p>The rolling (para-oesophageal) hiatus hernia is much less common than the sliding type. The GOJ remains in its normal location while a portion of the stomach herniates above the diaphragm.</p><p>The mixed or compound hiatal hernia is the most commonest type of para-oesophageal hernia. The GOJ is displaced into the thorax with a large portion of the stomach, which is usually abnormally rotated.</p><h5>Complications</h5><p>HH containing stomach may result in <a href="/articles/gastric-volvulus">gastric volvulus</a>, which in turn presents as intestinal obstruction and may result in ischaemia/infarction. </p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul><li>retrocardiac opacity with air-fluid level </li></ul><h4>Differential diagnosis</h4><p>On a frontal chest radiograph consider:</p><ul>
- +<li>retrocardiac <a href="/articles/lung-abscess">lung abscess</a>
-</ul><h4>See also</h4><ul><li><a href="/articles/abdominal-hernia">abdominal herniae</a></li></ul><p> </p>- +</ul><h4>See also</h4><ul><li><a href="/articles/abdominal-hernia">abdominal hernia</a></li></ul>
References changed:
- 3. Kahrilas PJ, Kim HC, Pandolfino JE. Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol. 2008;22 (4): 601-16. <a href="http://dx.doi.org/10.1016/j.bpg.2007.12.007">doi:10.1016/j.bpg.2007.12.007</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2548324">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/18656819">Pubmed citation</a><span class="auto"></span>
- 4. Govoni A, Whalen J, Kazam E. RadioGraphics. 1983;3 (4): . <a href="http://dx.doi.org/10.1148/radiographics.3.4.612">doi:10.1148/radiographics.3.4.612</a><span class="auto"></span>
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Image 15 CT (C+ portal venous phase) ( update )
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