Hiatal Hernia

Overview
  • Hiatal Hernias occur when the esophagus partially or completely separates from its fusion with the diaphragm and results in partial herniation of the stomach into the thorax. Two major morphological subtypes of hiatal hernias exist and tend to produce distinct clinical consequences. Regardless of subtype, hiatal hernias are typically found in adults and increase in incidence with age.
Morphology
  • Sliding Hernia
    • Sliding hernias constitute the vast majority (95%) of hiatal hernias and result from upward movement of the entire gastroesophageal junction. Consequently, the proximate part of the stomach, the gastric fundus protrudes into the thorax.
  • Paraesophageal Hernia:
    • Paraesophageal hernias result when the gastroesophageal junction remains in place but a portion of the stomach (usually the greater curvature) slides next to the junction and thus herniates into the thorax.
Clinical Consequences
  • Sliding Hernias are typically asymptomatic but may be a risk factor for Gastroesophageal Reflux Disease (GERD). Paraesophageal hernias can become strangulated, resulting in dysphagia or chest pain, and require surgical correction.