Hiatal hernia and Morgagni hernia are sorts of diaphragmatic hernias that are rarely detected on transthoracic echocardiography. Although echocardiographic findings have an important role for differential diagnosis of cardiac masses, we often might overlook diaphragmatic hernia. We report three cases of diaphragmatic hernias having specific features. The first case is huge hiatal hernia that encroaches left atrium with internal swirling flow on transthoracic echocardiography. The second case is a hiatal hernia that encroaches on both atria, incidentally detected on preoperative echocardiography. The third case is Morgagni hernia which encroaches on the right atrium only. So, we need to consider possibility of diaphragmatic hernia when we find a cardiac mass with specific echocardiographic features.
Diagnosis, Differential ; Echocardiography ; Heart Atria ; Hernia ; Hernia, Diaphragmatic* ; Hernia, Hiatal

Gastric volvulus can either present as an acute or chronic symptoms according to the degree of gastric rotation and subsequent obstruction. The diagnosis of gastric volvulus is often difficult and is mainly based on imaging studies. We describe a case of mesenteroaxial gastric volvulus associated with paraesophageal hernia, well demonstrated on upper gastrointestinal (UGI) series and coronal reconstructed CT image.
Diagnosis ; Hernia, Hiatal* ; Intestinal Volvulus* ; Stomach Volvulus ; Stomach*

The differential diagnosis between pericardial and non-cardiac masses may be sometimes difficult in the evaluation of chest mass adjacent to the heart. One misdiagnosed case of non-cardiac mass as a pericardial mass turned out to be a hernia. When the contents of hernia originate from the gastrointestinal tract, the diagnosis is made easily by air-fluid shadow on plain chest roentgenogram. Morgagni hernia is usually detected on plain chest roentgenograms as a smooth, supradiaphragmatic shadow at the right pericardiophrenic angle. In the case of Morgagni hernia, in which the contents are only the omentum, it is necessary to differentiate the hernia from mediastinal fatty tumors. We report two cases of hiatal and Morgagni hernia containing omentum which were misdiagnosed as pericardial masses.
Diagnosis ; Diagnosis, Differential ; Gastrointestinal Tract ; Heart ; Hernia* ; Hernia, Hiatal ; Lipoma* ; Omentum ; Thorax

The incidence of Congenital diaphragmatic hernia is 1 in 2000-5000 live births and hiatal hernia is even rarer especially in neonates. We experienced a case of congenital hiatal hernia (mixed type) in a week old female. Upon confirmation of the diagnosis, the surgery was done. Through the right thoracotomy, Belsey-Mark IV fundoplication was performed after the reduction of herniated viscera. The patient was fed 3 days after operation. there has been no complaint for 6 months after discharge. Therefore, we present this case with overall review of the literature.
Diagnosis ; Female ; Fundoplication ; Hernia, Diaphragmatic ; Hernia, Hiatal* ; Humans ; Incidence ; Infant, Newborn* ; Live Birth ; Thoracotomy ; Viscera

Hernia, Hiatal ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Omentum ; Tomography, X-Ray Computed

Hiatal hernia is a common disease, which is always complicated with gastro-esophageal reflux. However, owing to restriction of diagnosis ability, the finding of hiatal hernia is still at low level in China. How to increase the finding or diagnosis of this disease and improve the life quality of patients, is an important task of radiologists and hernial surgeons. Surgery has been integrated into the therapy of hiatal hernia for a long time, but most surgeons still need to improve their recognition about its essence and the anti-reflux mechanism of lower esophagus. The purpose of surgery of hiatal hernia is not only to repair the defect, but to recover the anatomic structure and function of lower esophagus, as well as to rebuild anti-reflux barrier in stomach at the mean time. The key principle of surgery is to recover structure of GEJ, location of LES and the length of lower esophagus through fundoplication and firm fixation, which prevent it from dislocating to thoracic cavity. By adhering to the principle of this, we can combine the anatomy and function in repair of hiatal hernia, and recover and keep the anti-reflux function of LES utmost. MDT, specialized precision program and standardization will play more and more important roles in hiatal hernia therapy in the future. In this article, we made a review about the diagnosis and therapy history of hiatal hernia, as well as prospected the progress in the near future.
China ; Esophagus ; physiopathology ; Fundoplication ; Gastroesophageal Reflux ; Hernia, Hiatal ; diagnosis ; surgery ; Humans

Background :The incidence of gastroesophageal reflux disease(GERD)is increasing recently, but medical management for GERD has many limitations.Therefore,variable surgical treatments have been introduced. MATERIAL AND METHOD: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001.Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. RESULT: Mean age of the patients was 54.3 +/- 19.0 years.Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1 +/- 2.6 days.We routinely practiced follow-up endoscopy on postoperative 3rd,6th,9th,and 12th months.After remission for reflux and esophagitis,they were transferred to internal medicine department.Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded)had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms,postoperatively.We experienced 10%operation failure rate. CONCLUSION: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.
Diagnosis ; Endoscopy ; Esophageal Achalasia* ; Follow-Up Studies ; Gastroesophageal Reflux* ; Hernia, Hiatal* ; Humans ; Incidence ; Internal Medicine ; Korea ; Retrospective Studies

Gastropleural fistula is an uncommon condition which can be induced by a trauma, gastroesophagectomy, subphrenic abscess, malignancy, and or hiatal hernia. In the patient with a predisposing factor, gastropleural fistula must be considered when pneumothorax, pyothorax, hemothorax, or food materials in the chest tube is detected. Diagnosis can be confirmed by an esophagogastrogram or endoscopy. The prognosis is often very poor with conservative care needed, along with a fistulectomy reguiring repair of orifice. We experienced a case of gastropleural fistula treated by endoscopic injection of Histoacryl and report it here with a review of related literature.
Causality ; Chest Tubes ; Diagnosis ; Empyema, Pleural ; Enbucrilate ; Endoscopy ; Fistula* ; Hemothorax ; Hernia, Hiatal ; Humans ; Pneumothorax ; Prognosis ; Subphrenic Abscess

BACKGROUNDS/AIMS: The prevalence of reflux esophagitis has been considered to be low in Korea, but recent studies suggested that it has been increasing. The prevalence also is generally thought to be less in Korea compared to that in western countries. METHODS: Data was collected from the leading medical journals published in Korea dealing with the prevalence of reflux esophagitis for last 10 years between 1990 and 1999 and annual reports of Health Promotion Center in Asan Medical Center of 1997 to 1999. RESULTS: The prevalence was occupied 1.3% in the early period of 1990's, 5.3% in the middle and 7.2% in the late period in symptomatic group and 2.7%, 3.2% and 5.8% in asymptomatic group. The prevalence was reported 5.4% in 1997, 5.3% in 1998 and 7.0% in 1999 in asymptomatic group of annual report of Health Promotion Center in Asan Medical Center. Associated conditions in reflux esophagitis were hiatal hernia, alcohol consumption, smoking and obesity suggesting as risk factors. CONCLUSIONS: The prevalence of reflux esophagitis in Korea has increased in last 10 years of 1990's but is still lower than that in the western countries. Continuous increase in the prevalence of reflux esophagitis in Korea is predictable and it leads to a greater concern for accurate diagnosis and rapid treatment of symptoms.
Adult* ; Alcohol Drinking ; Chungcheongnam-do ; Diagnosis ; Esophagitis, Peptic* ; Health Promotion ; Hernia, Hiatal ; Humans ; Korea ; Obesity ; Prevalence* ; Risk Factors ; Smoke ; Smoking

BACKGROUND AND AIMS: The importance of esophageal hiatal hernias in the pathogenesis of gastroesophageal reflux disease has been debated. It has been reported that a variety of factors are associated with hiatal hernias and esophagitis. The purpose of this study was to determine the correlation between hiatal hernia, reflux esophagitis and weight, alcohol, smoking, coffee and H. pylori infection. METHODS: 660 consecutive patients who had undergone an esophagogastroduodenoscopy due to upper gastrointestinal symptoms were reviewed. A diagnosis of hital hernia was made when the distance between the diaphragmatic crus and the tubular esophagus exceeded 1.5 cm, and the presence of a hernia sac at the U turn of the scope. RESULTS: Among the 660 cases, 71 cases (10.8%) of hiatal hernia and 30 cases (4.5%) of reflux esophagitis were noted. The male-to-female ratio was 1.6:1 and 4.3:1, respectively. The most common age group involved the fifth decade and sixth decade. Reflux esophagitis was found in 13 (18.3%) of 71 patients with hiatal hernias. Hiatal hernias were found in 36 (17.9%) of 201 patients who were overweight (BMI>23) and in 43 (23%) of 187 patients who were smokers. Reflux esophagitis was found in 23 (11.9%) of 194 patients who were alcohol drinkers and in 21 (11.2%) of 187 patients who were smokers. H. pylori infection was present in 36 (50.7%) of 71 patients with hiatal hernias, and 17 (56.2%) of 30 patients with reflux esophagitis. CONCLUSIONS: The rate of the hiatal hernia was significantly higher in patients who were overweight and smokers. The rate of reflux esophagitis was significantly higher in patients who were alcohol drinkers and smokers. But in multivariate analysis, none were risk factors associated with hiatal hernias or reflux esophagitis.
Coffee* ; Diagnosis ; Endoscopy, Digestive System ; Esophagitis ; Esophagitis, Peptic* ; Esophagus ; Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal* ; Humans ; Multivariate Analysis ; Overweight ; Risk Factors ; Smoke* ; Smoking*