What Is a Paraesophageal Hiatal Hernia?

Emergency surgery may be required if you have complications

Stressed Businessman
Brzi/E+/Getty Images

A paraesophageal hernia is the less common of the two types of hiatal hernia. It occurs when the upper part of the stomach pushes through an opening in the diaphragm and up into the chest. Learn about this condition and its causes, symptoms, and treatment.

What Happens in Paraesophageal Hiatal Hernia

A hernia means that an internal body part has been pushed into an area where it doesn't belong. Your torso is divided into the chest cavity where the lungs and heart are located and the abdomen where your stomach, intestines, and several other organs are located.

The chest cavity and abdomen are separated by a sheet of muscle, the diaphragm.

The esophagus is the tube through which food and drink pass from the mouth to the stomach, and it travels through an opening in the diaphragm, the hiatus. Hence the name hiatal hernia. The esophagus shortens and lengthens during swallowing, and with a hernia, the stomach and/or the junction of the stomach and esophagus can get pulled through the hiatus.

There are two types of hiatal hernias:

  • Sliding hernia (way more common)
  • Paraesophageal hernia (not very common)

With paraesophageal hernias, the gastro-esophageal junction (where the esophagus attaches to the stomach) remains where it belongs, but part of the stomach is squeezed up into the chest beside the esophagus. The portion of the stomach that is on the wrong side of the hiatus remain in the chest at all times. With this type of hernia, complications can occur.

Symptoms

Paraesophageal hernias often do not display any symptoms, but when symptoms are present, they are as follows:

  • Sudden severe chest pain
  • Radiating chest pain that isn't relieved by taking an antacid
  • Difficulty swallowing
  • Stomach pain
  • Indigestion
  • Nausea
  • Vomiting
  • Retching

Complications of a Paraesophageal Hiatal Hernia

  • Incarceration: This is when a stomach is stuck and being squeezed or constricted. It can lead to strangulation.
  • Strangulation: This results from the blood supply to the stomach getting cut off. The tissues of the stomach can't live without a blood supply and so they die. 
  • Bleeding: Erosions and ulcers called Cameron lesions may develop. As with other ulcers, these can lead to slow blood loss and anemia.
  • Gastric volvulus: This refers to twisting of the stomach, which can cause problems swallowing, pain just below the ribs, and retching.
  • Breathing Problems: A large hernia may squeeze the lungs.

Surgery for Paraesophageal Hiatal Hernia

Surgery is needed in any person who has symptoms from their paraesophageal hernia. Emergency surgery is needed for complications such as bleeding that cannot be stopped, breathing problems, stomach twisting, incarceration, or strangulation. 

Hiatal hernia surgery is commonly done as a laparoscopic procedure. The laparoscope is a thin, telescope-like instrument with a camera on the end that enables the surgeon to view the inside of the abdomen. With this type of surgery, small incisions are made in the abdomen. The laparoscope and surgical instruments are inserted through these incisions. During the surgery, the stomach is repositioned (pulled down) and the hiatus (the hole in the diaphragm) is reinforced so that the stomach does not move back up again.

Sources:

Paraesophageal Hernia (Hiatal Hernia). Medical College of Wisconsin. http://www.mcw.edu/General-Surgery/Patient-Info/GERD-Surgery-Program/Paraesophageal-Hernia.htm.

Rosen M, Blatnik J. Surgical management of paraesophageal hernia. UpToDate. http://www.uptodate.com/contents/surgical-management-of-paraesophageal-hernia.

Continue Reading