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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Primary parahiatal hernias: A case report and review of the literature
Silviu Daniel Preda, Ștefan Pătraşcu, Bogdan Silviu Ungureanu, Daniel Cristian, Vasile Bințințan, Cristian M Nica, Valentin Calu, Victor Strâmbu, Konstantinos Sapalidis, Valeriu Marin Șurlin
Silviu Daniel Preda, Ștefan Pătraşcu, Valeriu Marin Șurlin, 1st Clinic of Surgery, Clinical Emergency Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Craiova 200642, Dolj, Romania
Bogdan Silviu Ungureanu, Gastroenterology Clinic, Clinical Emergency Hospital of Craiova, University of Medicine and Pharmacy of Craiova, Craiova 200642, Dolj, Romania
Daniel Cristian, Departament of General Surgery, “Colțea” Clinical Hospital, Carol Davilla University of Medicine and Pharmacy, Bucharest 030171, Romania
Vasile Bințințan, 1st Clinic of Surgery of Cluj Napoca, Iuliu Hațieganu University of Medicine and Pharmacy Cluj Napoca, Cluj Napoca 400006, Cluj, Romania
Cristian M Nica, 3rd Clinic of Surgery, Timișoara Emergency Clinical County Hospital, “Victor Babeș” University of Medicine and Pharmacy of Timișoara, Timisoara 300723, Romania
Valentin Calu, Clinic of Surgery, “Elias” Emergency University Hospital Bucharest, University of Medicine and Pharmacy “Carol Davila”, Bucharest 011461, Romania
Victor Strâmbu, Clinic of Surgery of “Dr. Carol Davila” Nephrology Clinical Hospital, University of Medicine and Pharmacy “Carol Davila”, Bucharest 010731, Romania
Konstantinos Sapalidis, 3rd Surgery Clinic, University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Salonic 54636, Greece
Author contributions: Preda SD, Pătraşcu S, Ungureanu BS, Cristian D, Bințințan V, Nica CM, Calu V, Strâmbu V, Sapalidis K, Șurlin VM contributed to the writing and revising of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of data and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict 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 that 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: Silviu Daniel Preda, MD, Surgeon, General Surgery Resident, Craiova Emergency Clinical County Hospital, University of Medicine and Pharmacy of Craiova, Ceahlăului 39, Craiova 200635, Dolj, Romania.
sdpreda@gmail.com
Telephone: +40-76-8603624 Fax: +40-25-1534523
Received: September 3, 2019
Peer-review started: September 3, 2019
First decision: September 23, 2019
Revised: October 19, 2019
Accepted: November 23, 2019
Article in press: November 23, 2019
Published online: December 6, 2019
Processing time: 93 Days and 14 Hours
BACKGROUND
Parahiatal hernias (PHHs) are rare occurring disease, with a reported incidence of 0.2%-0.35% in patients undergoing surgery for hiatal hernia. We found only a handful of cases of primary PHHs in the literature. The aim of this paper is to present a case of a primary PHH and perform a systematic review of the literature.
CASE SUMMARY
We report the case of a 60-year-old Caucasian woman with no history of thoraco-abdominal surgery or trauma, which accused epigastric pain, starting 2 years prior, pseudo-angina and bloating. Based on imagistic findings the patient was diagnosed with a PHH and an associated type I hiatal hernia. Patient underwent laparoscopic surgery and we found an opening in the diaphragm of 7 cm diameter, lateral to the left crus, through which 40%-50% of the stomach had herniated in the thorax, and a small sliding hiatal hernia with an anatomically intact hiatal orifice but slightly enlarged. We performed closure of the defect, suture hiatoplasty and a “floppy” Nissen fundoplication. Postoperative outcome was uneventful, with the patient discharged on the fifth postoperative day. We performed a review of the literature and identified eight articles regarding primary PHH. All data was compiled into one tabled and analyzed.
CONCLUSION
Primary PHHs are rare entities, with similar clinical and imagistic findings with paraesophageal hernias. Treatment usually includes laparoscopic approach with closure of the defect and the esophageal hiatus should be dissected and analyzed. Postoperative outcome is favorable in all cases reviewed and no recurrence is cited in the literature.
Core tip: We present the management of a case with primary parahiatal hernia associated with type I hiatal hernia, from the imagistic findings that led us to the preoperative diagnosis to its surgical treatment. We also performed a review of the literature, which emphasizes the uniqueness and rarity of this disease. Frequently, the presentation is in an acute setting with the most cited complications being incarceration/perforation of the stomach and mezenteroaxial volvulus. Treatment includes closure of the defect and postoperative outcome is favorable in all cases we reviewed, with no cited recurrence.
