Published online Mar 16, 2019. doi: 10.4253/wjge.v11.i3.249
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
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.