Abstract
We present a case report of an incarcerated paraesophageal hernia containing a duodenal perforation managed with surgery. The patient is a 65-year-old female with super morbid obesity (BMI 67) and severe malnutrition (albumin 2.9) found to have a large paraesophageal hernia with free air and fluid in the chest and abdomen. On presentation, the patient was in septic shock, and she was taken emergently to the operating room for exploratory laparotomy. Operative findings included an incarcerated paraesophageal hernia with a 3-cm posterior duodenal perforation. A distal gastrectomy with Billroth-II reconstruction and gastropexy were performed. The patient ultimately recovered well and was discharged home. We report a positive outcome in a rare and dangerous case of an incarcerated paraesophageal hernia associated with duodenal perforation and septic shock.
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References
Dellaportas D, Papaconstantinou I, Nastos C, Karamanolis G, Theodosopoulos T (2018) Large paraesophageal hiatus hernia: Is Surgery Mandatory? Chirurgia (Bucur). 113(6):765–771. https://doi.org/10.21614/chirurgia.113.6.765
Ekelund M Ribbe E Willner J Zilling T 2006 Perforated peptic duodenal ulcer in a paraesophageal hernia--a case report of a rare surgical emergency BMC Surg 6 1. Published 2006 Jan 26. https://doi.org/10.1186/1471-2482-6-1
Linn KA, Guenther J, Pagel PS (2014) Hematemesis and free air under the diaphragm: just another perforated duodenal ulcer or something more unusual? J Cardiothorac Vasc Anesth. 28(1):200–201. https://doi.org/10.1053/j.jvca.2013.02.004
Shiwani MH, Thornton MP (2008) Supradiaphragmatic perforated duodenal ulcer in a giant hiatus hernia. Can J Surg. 51(4):E89–E90
Otsuka Y, Nara S, Ito K, Nakajima K, Mieno H, Konishi T (2002) Perforated duodenal ulcer associated with an incarcerated hiatal hernia: report of a case. Surg Today. 32(12):1085–1087. https://doi.org/10.1007/s005950200219
Morrow EH, Chen J, Patel R et al (2018) Watchful waiting versus elective repair for asymptomatic and minimally symptomatic paraesophageal hernias: a cost-effectiveness analysis. Am J Surg. 216(4):760–763. https://doi.org/10.1016/j.amjsurg.2018.07.037
Khanna A, Finch G (2011) Paraoesophageal herniation: a review. Surgeon. 9(2):104–111. https://doi.org/10.1016/j.surge.2010.10.010
Siegal SR, Dolan JP, Hunter JG (2017) Modern diagnosis and treatment of hiatal hernias. Langenbecks Arch Surg. 402(8):1145–1151. https://doi.org/10.1007/s00423-017-1606-5
Reiffel AJ, Barie PS, Spector JA (2013) A multi-disciplinary review of the potential association between closed-suction drains and surgical site infection. Surg Infect (Larchmt). 14(3):244–269. https://doi.org/10.1089/sur.2011.126
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Adetunji, A., O’Brien, V. & Goldberg, M.B. Successful Surgical Management of a Perforated Duodenal Ulcer Within an Incarcerated Paraesophageal Hernia. Indian J Surg (2024). https://doi.org/10.1007/s12262-024-04037-6
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DOI: https://doi.org/10.1007/s12262-024-04037-6