Dysphagia and reflux caused by a giant hiatal hernia.Hiatal hernias may be categorized as paraesophageal or sliding. Paraesophageal hiatal hernias are rare hernias involving migration of the gastric fundus fundus /fun·dus/ (fun´dus) pl. fun´di [L.] the bottom or base of anything; the bottom or base of an organ, or the part of a hollow organ farthest from its mouth. into the thorax thorax, body division found in certain animals. In humans and other mammals it lies between the neck and abdomen and is also called the chest. The skeletal frame of the thorax is formed by the sternum (breastbone) and ribs in front and the dorsal vertebrae in back. while the gastroesophageal gastroesophageal /gas·tro·esoph·a·ge·al/ (-e-sof?ah-je´al) 1. pertaining to the stomach and esophagus. 2. proceeding from the stomach to the esophagus. junction remains below the diaphragm. Sliding hiatal hernias, by far more common, involve migration of both the gastroesophageal junction and the stomach into the thorax; they place patients at risk for reflux. A 94-year-old woman presented with subjective dysphagia, globus, and episodic "choking" spells after eating. Transnasal esophagoscopy (TNE TNE The Net Effect (UK) TNE Trusted Network Environment TNE The New Economics TNE Trans-Nasal Esophagoscopy TNE Test Nacelle Equipment TNE Thermal Noise Effect TNE Tina Network Element ) demonstrated a large sliding hiatal hernia cavity that was lined with gastric rugae rugae (roo´gē, roo´jē), n.pl the irregular ridges in the mucous membrane covering the anterior part of the hard palate. rugae area, n See area, rugae. and a distally visible lumen (figure, A). The lumen closed with sniffing and opened at rest, indicating that it was at the level of the diaphragm. A barium-swallow study confirmed the giant sliding hiatal hernia (figure, B). In view of the patient's age and comorbidities, no surgical intervention was performed. Aggressive antireflux management with a twice-daily proton-pump inhibitor was initiated, and her symptoms abated. [FIGURES OMITTED] From the Center for Voice and Swallowing Disorders of Wake Forest University, Winston-Salem, N.C.; www.wfubmc.edu/voice |
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