Esophageal hiatus hernia

Q) What is type III esophageal hernia? 

a) Paraesophageal hiatus hernia

b) Sliding hiatus hernia

c) Both sliding and paraesophageal hernia

d) Large part of stomach in the mediastinum with pylorus near the esophageal hiatus


Answer  c

Hiatal hernias are protrusion of stomach through a defect in the esophageal hiatus into the mediastinum.

They are of four  types of hiatus hernia

  1. Sliding - GE junction migrates to the mediastinum and rests superior to the diaphragm.
  2. Paraesophgaeal - Part of stomach migrates through the esophageal hiatus into the mediastinum with GE junction remaining at its normal position.

paraesophgeal hiatus hernia

  1. There are IV types of hiatal hernia

Type I Sliding hernia

Type II Paraesophageal hernia

Type III - Both Type I and Type II together, both GE junction and stomach are in the medistiunum.

Type IV -Most part of the stomach (more than 1/3rd of stomach)  in the mediastinum .  This is also known as giant hiatus hernia

Sliding hiatus hernias are very common and often do not lead to symptoms. Mostly they require no treatment. Paraesophageal hernias may require surgery if they produce symptoms.

Structures passing through esophageal hiatus are 

  1. Oesophagus and and branches of left gastric vein & artery

2. Lymphatics

3. Right and left vagus nerves

Factors which lead to formation of hiatus hernia

  1. Widening of diaphragmatic crura at esophagus hiatus
  2. Streching of phrenoesophageal membrane

Symptoms 

  1. Dysphagia
  2. Odynophagia
  3. Early satiety