Hsu CT, Hsiao PJ, Chiu CC, Chan JS, Lin YF, Lo YH, Hsiao CJ. Terminal ileum gangrene secondary to a type IV paraesophageal hernia. World J Gastroenterol 2016; 22(8): 2642-2646 [PMID: 26937153 DOI: 10.3748/wjg.v22.i8.2642]
Corresponding Author of This Article
Chia Jen Hsiao, MD, Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, No.168, Jhongsing Road, Longtan Township, Taoyuan 32551, Taiwan. sjrvincent@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which 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/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Hsu CT, Hsiao PJ, Chiu CC, Chan JS, Lin YF, Lo YH, Hsiao CJ. Terminal ileum gangrene secondary to a type IV paraesophageal hernia. World J Gastroenterol 2016; 22(8): 2642-2646 [PMID: 26937153 DOI: 10.3748/wjg.v22.i8.2642]
World J Gastroenterol. Feb 28, 2016; 22(8): 2642-2646 Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2642
Terminal ileum gangrene secondary to a type IV paraesophageal hernia
Ching Tsai Hsu, Po Jen Hsiao, Chih Chien Chiu, Jenq Shyong Chan, Yee Fung Lin, Yuan Hung Lo, Chia Jen Hsiao
Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Po Jen Hsiao, Tri-Service General Hospital, National Defense Medical Center, Taoyuan 32551, Taiwan
Po Jen Hsiao, Jenq Shyong Chan, Division of Nephrology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Yee Fung Lin, Division of General Surgery, Department of Surgery, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Chia Jen Hsiao, Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan
Author contributions: Hsu CT wrote the paper; Hsiao PJ, Chiu CC, Chan JS, Lin YF, Lo YH and Hsiao CJ contributed equally to this work.
Supported by Taoyuan Armed Forces General Hospital.
Institutional review board statement: The study was reviewed and approved by the Taoyuan Armed Forces General Hospital, Taiwan Institutional Review Board.
Informed consent statement: This case is presented for medical communication only, not for other purposes; The images in this paper do not disclose the patient’s information; Consent was obtained from the patient for publication of this study.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Correspondence to: Chia Jen Hsiao, MD, Division of Gastroenterology, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, No.168, Jhongsing Road, Longtan Township, Taoyuan 32551, Taiwan. sjrvincent@gmail.com
Telephone: +886-3-4801625 Fax: +886-3-4801625
Received: June 9, 2015 Peer-review started: June 12, 2015 First decision: July 10, 2015 Revised: August 5, 2015 Accepted: October 12, 2015 Article in press: October 13, 2015 Published online: February 28, 2016 Processing time: 260 Days and 21.2 Hours
Abstract
Type IV paraesophageal hernia (PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type IV PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in PubMed. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type IV PEH with incarceration of only the terminal ileum.
Core tip: Type IV paraesophageal hernias (PEH) is very rare, occurring in only 2%-5% of all PEH cases. The clinical course of PEH may present with minimal symptoms, but potentially life-threatening complications such as strangulation, necrosis, or perforation could occur. Early recognition and prompt therapy of these hernias and associated comorbidities are crucial.
