Acute abdomen in a patient with paraesophageal hernia, resulting in acute compromised respiratory function: A case report. (2017)

• Record Type: Journal Article
• Authors: Mekhael, Mira; El-Hussuna, Alaa
• Is Part Of: International journal of surgery case reports. Volume 31(2017)
• Page Start: 180
• Page End: 183
• Publication Date: 2017
• Subjects: Paraesophageal hernia -- Acute abdomen -- Compromised respiratory function -- Elective hernia repair -- Watchful waiting -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.01.051
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: A paraesophageal hernia can be complicated by a case of acute abdomen. High intra-abdominal pressure can cause further herniation of a paraesophageal hernia. Severe herniation can possibly cause acute compromised respiratory function. Acute breathing difficulties in patients with a hernia should raise suspicion. Previous pulmonary symptoms from a hernia increase suspicion of this complication. Abstract: Introduction: We present a case of acute abdomen, causing increased intra-abdominal pressure, leading to further herniation of an existing paraesophageal hernia, and consequently acute compromised respiratory function. This acute respiratory complication to a paraesophageal hernia has not previously been reported. Presentation of case: We present a case of a 75-year-old female who was acutely admitted with stridor. The patient was known to have a paraesophageal hernia monitored using watchful waiting, and dyspnoea. The patient's condition deteriorated, leading to intubation. Diagnostic imaging revealed a paraesophageal hernia pressing onto the trachea as well as appendicitis and ileus. Surgery confirmed perforated appendicitis, peritonitis, and ileus causing high intra-abdominal pressure, resulting in further herniation of the paraesophageal hernia as a cause for acute compromised respiratory function. Appendectomy and gastropexy were performed. The patient was later discharged to rehabilitation. Discussion: Patients with pulmonary symptoms caused by a paraesophageal hernia, especially patients with sizeable hernias, could potentially be in greater risk of severe airway affection if complicated by acute abdomen. These patients could benefit from elective hernia repair, rather than watchful waiting, as it would eliminate pulmonary symptoms and prevent similar cases. Patients monitored using watchful waiting should be informed that acute abdomen could cause acute compromised respiratory function. Conclusion: Any case of acute abdomen causing high intra-abdominal pressure could potentially cause further herniation of an existing paraesophageal hernia, resulting in acute compromised respiratory function. In patients known to have a paraesophageal hernia, similar cases should be suspected if the patient presents with acute breathing difficulties.