Challenges in the Management of Giant Strangulated Hiatal Hernia: A Case Report.
- 1Mohammed VI Faculty of Medicine Mohammed VI University of Sciences and Health, UM6SS Casablanca Morocco um6ss.ma.
Abstract
A giant hiatal hernia (GHH) is generally defined as the herniation of more than half of the stomach into the thoracic cavity, although definitions vary in the literature, with some authors considering herniation of more than one-third of the stomach sufficient for diagnosis. Strangulation is a rare but life-threatening complication that may lead to vascular compromise, gastric ischemia, and ultimately necrosis, requiring urgent diagnosis and individualized surgical management. We report the case of a 54-year-old man with long-standing gastroesophageal reflux disease who presented with chest pain and recurrent vomiting. Contrast-enhanced computed tomography (CT) demonstrated a giant type III hiatal hernia with approximately two-thirds of the stomach herniated into the thoracic cavity and associated gastric obstruction. Emergency laparoscopy revealed a severely twisted stomach with extensive necrosis of the fundus and greater curvature. Given the size of the hernia, an adequate exposure of the hiatal area was difficult to achieve, necessitating conversion to a left subcostal laparotomy. After dissection of the two diaphragmatic crus, the sac was reduced and excised, allowing complete reduction of the stomach back into the abdominal cavity. The necrotic areas were managed by longitudinal atypical gastrectomy. Given the large hiatal defect, anterior cruroplasty was performed to prevent an excessive angulation of the esophagus. No antireflux system could be implemented as the fundus was fully removed and Staple-line integrity was confirmed by an intraoperative methylene blue leak test. The postoperative course was uneventful with minimal residual reflux, treated by proton pump inhibitor therapy. We provide this case to demonstrate the treatment of a giant strangulated hernia and challenges stemming from the alternative surgical approach in laparoscopic and robot-assisted practice.
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BibTeX
@article{nouri2026challenges,
title = {{Challenges in the Management of Giant Strangulated Hiatal Hernia: A Case Report.}},
author = {Abdellah Nouri and Youssef Ghaddou and Ahmed Bensaad and Abdelaziz Fadil and Khalid Sair},
journal = {Case reports in surgery},
year = {2026},
month = nov,
doi = {10.1155/cris/3464069},
url = {https://europepmc.org/article/MED/42999583},
note = {CC BY},
}
RIS
TY - JOUR
TI - Challenges in the Management of Giant Strangulated Hiatal Hernia: A Case Report.
AU - Abdellah Nouri
AU - Youssef Ghaddou
AU - Ahmed Bensaad
AU - Abdelaziz Fadil
AU - Khalid Sair
PY - 2026
DA - 2026/11/07
JO - Case reports in surgery
DO - 10.1155/cris/3464069
UR - https://europepmc.org/article/MED/42999583
AB - A giant hiatal hernia (GHH) is generally defined as the herniation of more than half of the stomach into the thoracic cavity, although definitions vary in the literature, with some authors considering herniation of more than one-third of the stomach sufficient for diagnosis. Strangulation is a rare but life-threatening complication that may lead to vascular compromise, gastric ischemia, and ultimately necrosis, requiring urgent diagnosis and individualized surgical management. We report the case of a 54-year-old man with long-standing gastroesophageal reflux disease who presented with chest pain and recurrent vomiting. Contrast-enhanced computed tomography (CT) demonstrated a giant type III hiatal hernia with approximately two-thirds of the stomach herniated into the thoracic cavity and associated gastric obstruction. Emergency laparoscopy revealed a severely twisted stomach with extensive necrosis of the fundus and greater curvature. Given the size of the hernia, an adequate exposure of the hiatal area was difficult to achieve, necessitating conversion to a left subcostal laparotomy. After dissection of the two diaphragmatic crus, the sac was reduced and excised, allowing complete reduction of the stomach back into the abdominal cavity. The necrotic areas were managed by longitudinal atypical gastrectomy. Given the large hiatal defect, anterior cruroplasty was performed to prevent an excessive angulation of the esophagus. No antireflux system could be implemented as the fundus was fully removed and Staple-line integrity was confirmed by an intraoperative methylene blue leak test. The postoperative course was uneventful with minimal residual reflux, treated by proton pump inhibitor therapy. We provide this case to demonstrate the treatment of a giant strangulated hernia and challenges stemming from the alternative surgical approach in laparoscopic and robot-assisted practice.
SN - 2090-6900
SN - 2090-6919
ER -