Scoliosis and spina bifida contributing to strangulation of a hiatus hernia: a case report

Hiatus hernia is defined as a trans-diaphragmatic protrusion of the intra-abdominal contents through the oesophageal hiatus into the mediastinum. Surgical repair is indicated in symptomatic patients, with some patients presenting emergently with strangulation and ischaemia of hernial contents. In this situation, emergent decompression and surgical repair is indicated. Although it has been suggested previously that kyphoscoliosis may contribute to development and progression of hiatus hernia, there are no published reports of obstruction being caused by severe spinal deformity. A 67-year-old male patient with spina bifida and severe scoliosis who presented with an obstructed hiatus hernia is discussed here. Because of his obstruction, laparoscopic hiatus hernia repair and fundoplication was undertaken. The patient had an uncomplicated recovery following this. This case highlights the importance of providing definitive management to patients with difficult anatomy, which has caused their obstruction, as conservative management is unlikely to lead to an optimal outcome.