Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2019; 11(3): 249-255
Published online Mar 16, 2019. doi: 10.4253/wjge.v11.i3.249
Rare sequalae of hiatal hernia causing pancreatitis and hepatitis: A case report
Muhammad Umar Kamal, Ahmed Baiomi, Mohamad Erfani, Harish Patel
Muhammad Umar Kamal, Ahmed Baiomi, Mohamad Erfani, Harish Patel, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
Ahmed Baiomi, Mohamad Erfani, Harish Patel, Division of Gastroenterology, Department of Medicine, BronxCare Hospital Center, Bronx, NY 10457, United States
Author contributions: Kamal MU, Baiomi A and Patel H contributed to concept and design, literature review, drafting of the manuscript; Baiomi A acquired the data and figures; Kamal MU, Baiomi A and Erfani M revised the manuscript; Patel H critically revised the manuscript for important intellectual content; all authors had access and approved the last version of the manuscript.
Informed consent statement: Informed consent for participation was obtained from this patient.
Conflict-of-interest statement: None of the authors have any financial conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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/
Corresponding author: Muhammad Umar Kamal, MD, Doctor, Department of Medicine, BronxCare Hospital Center, BronxCare Health system, 1650 Selwyn Ave, Suite #10C, Bronx, NY 10457, United States. muhammadumarkamal@gmail.com
Telephone: +1-718-9601234 Fax: +1-718-9602055
Received: January 22, 2019
Peer-review started: January 23, 2019
First decision: February 20, 2019
Revised: February 23, 2019
Accepted: March 11, 2019
Article in press: March 11, 2019
Published online: March 16, 2019
Processing time: 53 Days and 13.7 Hours
Abstract
BACKGROUND

Hiatal hernia (HH) contents commonly include stomach, transverse colon, small intestine, and spleen but herniation of the pancreas is an extremely rare phenomenon.

CASE SUMMARY

79-year-old female with multiple comorbidities presented to emergency department with complaints of weight loss for 6 mo and abdominal pain for one day. Physical examination revealed cachectic and dehydrated female and bowel sounds could be auscultated on the right side of chest. Computed tomography of the chest and abdomen revealed interval enlargement of a massive HH, containing stomach and much of the bowel as well as pancreas and distal extra-hepatic biliary duct, probably responsible for obstructive effect upon same. There was increased prominence of the pancreas consistent with pancreatitis. There was a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. Patient clinical status improved with conservative treatment.

CONCLUSION

HH presenting with acute pancreatitis is a serious diagnostic and therapeutic challenge. The initial management is conservative, even if the abdominal content has herniated to mediastinum. The incentive spirometry can be utilized in the conservative of the large HH. After stabilization of the patient, elective surgical intervention remains the mainstay of the management. Definitive treatment will vary from case to case depending on the acuity of situation and comorbidities.

Keywords: Hiatal hernia; Pancreatitis; Hepatitis; Para-esophageal hernia; Gastropexy; Pancreatic herniation; Diaphragmatic hernia; Percutaneous endoscopic gastrostomy; Case report

Core tip: Large hiatal hernia (HH) with inclusion of the pancreas in the hernial sac is extremely rare. We present a case of 79-year-old female with multiple comorbidities presented to emergency department with abdominal pain. Computed tomography of the chest and abdomen showed a large HH causing obstructive effect with dilated biliary system along gall bladder wall edema and pancreatitis. The acute pancreatitis can be from pancreatic trauma or ischemia. Transaminitis can be present from biliary traction or volvulus. As in our case, the conservative management includes incentive spirometry leading to the reduction of the hernia sac is essence of the treatment. The surgical intervention is the definitive treatment, although it varies on case to case based on the comorbidities and patient wishes.