Published online Mar 26, 2020. doi: 10.12998/wjcc.v8.i6.1180
Peer-review started: December 17, 2019
First decision: January 13, 2020
Revised: February 10, 2020
Accepted: March 5, 2020
Article in press: March 5, 2020
Published online: March 26, 2020
Processing time: 99 Days and 11.5 Hours
Giant paraesophageal hiatal hernias (HH) are very infrequent, and their spectrum of clinical manifestations is large. Giant HH mainly occurs in elderly patients, and its relationship with anemia has been reported. For the surgical treatment of large HH, Nissen fundoplication is the most common antireflux procedure, and the reinforcement of HH repair with a patch (either synthetic or biologic) is still debatable.
We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia. After performing a series of tests and diagnostic approaches, results showed a complete intrathoracic stomach associated with severe iron deficiency anemia. The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication. Postoperatively, reflux symptoms were markedly relieved, and the imaging study showed complete reduction of the hernia sac. More importantly, anemia was resolved, and hemoglobin, serum iron and ferritin level were returned to the normal range. The patient kept regular follow-up appointments and remained in a satisfactory condition.
This case report highlights the relationship between large HH and iron deficiency anemia. For the surgical treatment of large HH, laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.
Core tip: Giant paraesophageal hiatal hernia (HH) usually occurs in elderly patients and is relatively rare. We present a case of complete intrathoracic stomach in a 46-year-old male with reflux symptoms and severe iron deficiency anemia. The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication. Postoperatively, reflux symptoms and iron deficiency anemia were resolved. The patient remained in a satisfactory condition. This case highlights that large HH is a potential cause of iron deficiency anemia. For the surgical treatment of large HH, laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.