Hiatus hernia- what is it and it's prognosis?

[Pritha]

Hello, my sister's mother in law is 85-year-old. She has a history of hypertension, hyperlipidemia and recently diagnosed GERD. She was taken to hospital with acute onset shortness of breath, epigastric pain and chest pain. The pain was described as sharp and tearing in nature, 8/10 in intensity, and radiating to her back with severe associated shortness of breath. On physical examination, she was found to be hypotensive, tachycardic and in respiratory distress. Prominent bowel sounds were heard in the thoracic cavity. Initial EKG was not suggestive of ST elevation myocardial infarction. Blood work showed lactic acidosis. She was started on intravenous fluid boluses. An emergent CT angiogram of the chest was done to rule out aortic dissection. The CT scan revealed her entire stomach herniating into the thoracic cavity, compressing the heart and lungs. Doctor diagnosed hiatus hernia. She was taken emergently to the operating room and laparoscopic hiatal hernia repair was performed. What is Hiatus hernia? and what is the prognosis? Please comment.

[Aishee]

@pritha A hiatal hernia is a prolapse of the contents of the abdominal cavity into the mediastinum through the esophageal hiatus. It is a fairly common condition seen in up to half of the individuals older than 50 years of age. Although usually asymptomatic, hiatal hernias typically present as gastroesophageal reflux disease (GERD). Life-threatening cases are extremely rare and those reported are mostly in patients with comorbidities and incarcerated paraesophageal or mixed hiatal hernias. If left untreated, patients with a hiatus hernia may progress to develop strangulation, esophageal adenocarcinoma, and gastric volvulus. Prognosis is generally excellent and recovery after surgery in a large hernia is approximately 90%. The disease is well controlled with medical therapy but not cured.