Incarceration and Perforation of a Sliding Hiatus Hernia: Report of a Case

The potentially serious complications of paraoesophageal hiatus hernias are known but its counterpart the sliding hernia, is thought to be more benign in nature. We describe a 72 year old female admitted with epigastric pain after gorging on her Christmas meal, who proved a diagnostic difficulty for both the medical and surgical registrars and was found to have a perforated incarcerated sliding hiatus hernia on CT scan. A transhiatal oesophagectomy was performed as laparotomy findings confirmed a gangrenous perforated stomach and a gangrenous lower oesophagus. She recovered fully from the operation and is well to date. This case provides evidence that sliding hernias can cause serious complications and may be difficult to differentiate from other cardiovascular and abdominal pathologies. A high index of suspicion is required by medical professionals treating chest and epigastric pain.