Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2016; 22(8): 2642-2646
Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2642
Terminal ileum gangrene secondary to a type IV paraesophageal hernia
Ching Tsai Hsu, Po Jen Hsiao, Chih Chien Chiu, Jenq Shyong Chan, Yee Fung Lin, Yuan Hung Lo, Chia Jen Hsiao
Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Po Jen Hsiao, Tri-Service General Hospital, National Defense Medical Center, Taoyuan 32551, Taiwan
Po Jen Hsiao, Jenq Shyong Chan, Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Yee Fung Lin, Division of General Surgery, Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Chia Jen Hsiao, Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Author contributions: Hsu CT wrote the paper; Hsiao PJ, Chiu CC, Chan JS, Lin YF, Lo YH and Hsiao CJ contributed equally to this work.
Supported by Taoyuan Armed Forces General Hospital.
Institutional review board statement: The study was reviewed and approved by the Taoyuan Armed Forces General Hospital, Taiwan Institutional Review Board.
Informed consent statement: This case is presented for medical communication only, not for other purposes; The images in this paper do not disclose the patient’s information; Consent was obtained from the patient for publication of this study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chia Jen Hsiao, MD, Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, No.168, Jhongsing Road, Longtan Township, Taoyuan 32551, Taiwan. sjrvincent@gmail.com
Telephone: +886-3-4801625 Fax: +886-3-4801625
Received: June 9, 2015
Peer-review started: June 12, 2015
First decision: July 10, 2015
Revised: August 5, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: February 28, 2016
Processing time: 260 Days and 21.2 Hours
Abstract

Type IV paraesophageal hernia (PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type IV PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in PubMed. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type IV PEH with incarceration of only the terminal ileum.

Keywords: Gangrene; Hiatal; Ileum; Paraesophageal hernia; Thoracic cavity

Core tip: Type IV paraesophageal hernias (PEH) is very rare, occurring in only 2%-5% of all PEH cases. The clinical course of PEH may present with minimal symptoms, but potentially life-threatening complications such as strangulation, necrosis, or perforation could occur. Early recognition and prompt therapy of these hernias and associated comorbidities are crucial.