Risk factors include obesity, increased intra-abdominal pressure from various conditions, and a previous hiatal operation.
May be asymptomatic or may present with heartburn, dysphagia, odynophagia, hoarseness, asthma, shortness of breath, chest pain, anemia or hematemesis, or some combination of these.
Contrasted upper gastrointestinal series (also known as an upper GI or as a barium esophagram) is the key investigation.
Treatment depends on the patient's symptoms and the anatomic configuration of the hernia.
Uncomplicated sliding hiatal hernias are treated symptomatically with medical therapy, although some patients may select surgical therapy. Complicated hiatal hernias (those with bleeding, volvulus, or obstruction) have a stronger indication for surgical repair.
Complications include obstruction, bleeding, volvulus with and without strangulation or necrosis, and Barrett esophagus.
Hiatal hernia is the protrusion of intra-abdominal contents through an enlarged esophageal hiatus of the diaphragm. A hiatal hernia most commonly contains a variable portion of the stomach; less commonly, it may contain transverse colon, omentum, small bowel, or spleen, or some combination of these organs. The herniated contents are usually contained within a sac of peritoneum.
History and exam
Constantine T. Frantzides, MD, PhD, FACS
Chicago Institute of Minimally Invasive Surgery
Director of Minimally Invasive Surgery and Bariatric Fellowship Program
St. Francis Hospital
CTF declares that he has no competing interests.
Minh B. Luu, MD, FACS
Surgery Residency Associate Director
Rush University Medical Center
MBL declares that he has no competing interests.
Dr Constantine T. Frantzides and Dr Minh B. Luu would like to gratefully acknowledge Dr Mark A. Carlson, a previous contributor to this topic. MAC declares that he has no competing interests.
Frank A. Granderath, MD
Department of General, Visceral and Transplant Surgery
University Hospital Tuebingen
FAG declares that he has no competing interests.
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