Minding the Gap: Clinical Manifestations of a Rare Type IV Hiatal Hernia

Hiatal hernias are classified according to the increasing severity of protruding intra-abdominal viscera through the esophageal hiatus (types I-IV). Herein is the case of an elderly patient presenting with recent-onset dyspnea, postprandial gastroesophageal reflux, and hypoxemia. Imaging revealed a rare type IV hiatal hernia implicating the stomach and part of the pancreas. This case highlights the seemingly benign clinical manifestations of a massive hiatal hernia, despite its ability to complicate treatment or exacerbate comorbid conditions.