Perforated Strangulated Para-Oesophageal Hiatus Hernia: A Rare Cause of Acute Abdominal Pain

Para-oesophageal (rolling) hiatus herniae are less common than sliding hiatus herniae. They are more common in the elderly age group. Often asymptomatic, they may present with dysphagia, chest pain and a gastro-oesophageal reflux picture. The symptoms are thought to be due to twisting and distortion of the oesophagus and stomach. The hernia is usually present on a plain chest radiograph as an intrathoracic gas bubble, often with a fluid level behind the heart. The investigation of choice is usually a barium swallow. Because of the higher risk of complications with these herniae surgery is often indicated. Operative management can involve either thoracic or abdominal open approach, or may involve a laparoscopic repair with a fundoplication (1).