Work

Challenges in the Management of Giant Strangulated Hiatal Hernia: A Case Report

Year: 2026

Type: article

Abstract: A giant hiatal hernia (GHH) is generally defined as the herniation of more than half of the stomach into the thoracic cavity, although definitions vary in the literature, with some authors considering herniation of more than one-third of the stomach sufficient for diagnosis. Strangulation is a rare but life-threatening complication that may lead to vascular compromise, gastric ischemia, and ultimately necrosis, requiring urgent diagnosis and individualized surgical management. We report the case of a 54-year-old man with long-standing gastroesophageal reflux disease who presented with chest pain and recurrent vomiting. Contrast-enhanced computed tomography (CT) demonstrated a giant type III hiatal hernia with approximately two-thirds of the stomach herniated into the thoracic cavity and associated gastric obstruction. Emergency laparoscopy revealed a severely twisted stomach with extensive necrosis of the fundus and greater curvature. Given the size of the hernia, an adequate exposure of the hiatal area was difficult to achieve, necessitating conversion to a left subcostal laparotomy. After dissection of the two diaphragmatic crus, the sac was reduced and excised, allowing complete reduction of the stomach back into the abdominal cavity. The necrotic areas were managed by longitudinal atypical gastrectomy. Given the large hiatal defect, anterior cruroplasty was performed to prevent an excessive angulation of the esophagus. No antireflux system could be implemented as the fundus was fully removed and Staple-line integrity was confirmed by an intraoperative methylene blue leak test. The postoperative course was uneventful with minimal residual reflux, treated by proton pump inhibitor therapy. We provide this case to demonstrate the treatment of a giant strangulated hernia and challenges stemming from the alternative surgical approach in laparoscopic and robot-assisted practice.

Source: Case Reports in Surgery

DOI: 10.1155/cris/3464069

Authors: Abdellah Nouri, Youssef Ghaddou, Ahmed Bensaad, Abdelaziz Fadil, Khalid Sair

Institution: Université Mohammed VI des Sciences et de la Santé

Language: English

Topic: Gastroesophageal reflux and treatments

Subfield: Gastroenterology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $790