Intrathoracic drainage of a perforated prepyloric gastric ulcer with a type II paraoesophageal hernia

With an incidence of less than 5%, type II paraesophageal hernias are one of the less common types of hiatal hernias. We report a case of a perforated prepyloric gastric ulcer which, due to a type II hiatus hernia, drained into the mediastinum.Case presentationA 61-year old Caucasian man presented with acute abdominal pain.

On a conventional x-ray of the chest a large mediastinal air-fluid collection and free intra-abdominal air was seen. Additional computed tomography revealed a large intra-thoracic air-fluid collection with a type II paraesophageal hernia.

An emergency upper midline laparotomy was performed and a perforated pre-pyloric gastric ulcer was treated with an omental patch repair. The patient fully recovered after 10 days and continues to do well.

Conclusion: Type II paraesophageal hernia is an uncommon diagnosis.

The main risk is gastric volvulus and possible gastric torsion. Intrathoracic perforation of gastric ulcers due to a type II hiatus hernia is extremely rare and can be a diagnostic and treatment challenge.

Author: Robert A Pol, Hiske W Wiersma, Bas JGL Zonneveld and Marinus Eeftinck Schattenkerk
Credits/Source: World Journal of Emergency Surgery 2008, 3:34

Published on: 2008-12-08

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