Paraesophageal Hernia in a Newborn Mimicking Esophageal Atresia

A defect of the esophageal hiatus can lead to herniation of the stomach or other abdominal organs into the thoracic cavity, a condition called hiatal hernia. They constitute a rare clinical entity during infancy and childhood and their symptoms can be non-specific or subtle, making the diagnosis difficult even for experienced clinicians. In all cases, surgical treatment of the defect is necessary because of life-threatening complications. We present a rare case of a newborn with congenital paraesophageal hernia (CPEH) and microgastria, who was initially referred to our center with the diagnosis of esophageal atresia due to the inability to pass an orogastric tube beyond 15 cm from the gum margin. A contrast study revealed the CPEH. The patient underwent emergent surgery and has had no signs of recurrence until now. Although the diagnosis can be very tricky and mimic other conditions, a high level of suspicion should exist especially in patients with persistent symptoms of gastroesophageal reflux or recurrent respiratory infections. In neonates, signs and symptoms can be indicative of esophageal obstruction which should be ruled out with an upper gastrointestinal (GI) study.