Anonymous User
Login / Registration

a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2019; 73(3): 220–227. doi:10.14735/amgh2019220.

Acute complications of hiatal hernias

Vladimír Procházka  1, Filip Marek1, Lumír Kunovský1,2, Vladimír Čan1, Jiří Dolina  3, Radek Kroupa  4, Milan Dastych  5, Jitka Vaculová3, Daniel Bartušek  6, Jaroslav Ivičič7, Zdeněk Kala  1

+ Affiliation


Hiatal hernias are often associated with treatment of gastroesophageal reflux disease. In such cases, continuation of proton pump inhibitor treatment or surgery is often considered. The rate of complications is low in cases with small hiatal hernias. Unfortunately, the risk of potentially life-threatening acute complications increases as the hernia size grows. Prevention is an important component of hiatal hernia treatment. Planned surgical repair of hiatal hernias is associated with very good functional outcomes and a low risk of postoperative complications. Thus, paraesophageal and large mixed hiatal hernias should be operated on in advance. The most common acute complications of hiatal hernias are stomach volvulus and severe bleeding. Stomach volvulus is a life-threatening acute condition that must be rapidly diagnosed and treated. Its typical symptoms might not be present in every patient and it can be difficult to establish an exact diagnosis. The basis of acute complications of surgical treatment of hiatal hernias is repositioning of the stomach into the abdominal cavity and of the stomach pexis into the abdominal wall. In acute surgery of a large hiatal hernia, the risks are significantly greater with laparotomy than with elective surgery, which usually involves laparoscopy. There is an increased risk of perioperative injury of the esophagus and spleen as well as non-surgical postoperative complications such as pneumonia, delirium, and arrhythmia. Endoscopic treatment might also be an option in specific patients with stomach volvulus without stomach wall perforation. Acute surgery is also required for cases with massive bleeding from a huge hiatal hernia when the possibilities for endoscopic and conservative treatment are limited.


endoscopy, fundoplication, hiatal hernia, GIT bleeding, laparoscopy, reflux esophagitis, stomach volvulus

To read this article in full, please register for free on this website.

Benefits for subscribers

Benefits for logged users


1. Manes G, Pieramico O, Uomo G et al. Reationship of sliding hiatus hernia to gastroesophageal reflux disease: a possible role for Helicobacter pylori infection? Dig Dis Sci 2003; 48 (2): 303–307.
2. Ténaiová J, Tůma L, Hrubant K et al. Výskyt hiátové hernie v běžné endoskopické praxi. Čas Lék čes 2007; 146 (1): 74–76.
3. Richter J. Gastroesophageal reflux disease. In: Textbook of gastroenterology. Yamada T (ed). Philadelphia: Lippincott Williams & Wilkins 2003: 1196–1224.
4. Bureš J, Hep A, Jirásek V et al. Refluxní choroba jícnu: standardy České gastroenterologické společnosti – aktualizace 2009. Čes a Slov Gastroent a Hepatol 2009; 63 (2): 76–85.
5. Haas O, Rat P, Christophe M et al. Surgical results of intrathoracic gastric volvulus complicating hiatal hernia. Br J Surg 1990; 77 (12): 1379–1381.
6. Treacy PJ, Jamieson GG. An approach to the management of para-oesophageal hiatus hernias. Aust N Z J Surg 1987; 57 (11): 813–817.
7. Kasalický M, Koblihová E. Chirurgie hiátové kýly a refluxní choroby jícnu, Nissen nebo Toupet? Rozhl Chir 2015; 94 (12): 510–515.
8. Zeman M, Krška Z et al. Speciální chirurgie. Praha: Galén 2014: 139.
9. Sihvo EI, Salo JA, Räsänen JV et al. Fatal complication of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg 2009; 137 (2): 419–424. doi: 10.1016/j.jtcvs.2008.05.042.
10. Aly A, Munt J, Jamieson GG et al. Laparoscopic repair of large hiatal hernias. Br J Surg 2005; 92 (5): 648–653.
11. Pizza F, Rossetti G, Limognelli P et al. Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol 2007; 13 (5): 740–747. doi: 10.3748/wjg.v13.i5.740.
12. Tedesco P, Lobo E, Fisichella PM et al.  Laparoscopic fundoplication in elderly patients with gastroesophageal reflux disease. Arch Surg 2006; 141 (3): 289–292. doi: 10.1001/ archsurg.141.3.289.
13. Ruer V, Champault G. Diaphragmatic hernias, excluding hiatal hernias with gastroesophageal reflux. J Chir 2007; 144 (4): 23–26.
14. Ozdemir IA, Burke WA, Ikins PM. Paraesophageal hernia. A life-threating disease. Ann Thorac Surg 1973; 16 (6): 547–554.
15. Luketich JD, Raja S, Fernando HC et al. Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg 2000; 232 (4): 608–618.
16. Fumagalli U, Bona S, Caputo U et al. Are Surgisis biomeshes effective in reducing recurrences after laparoscopic repair of large hiatal hernias? Surg Laparosc Endosc Percutan Tech 2008; 18 (5): 433–436. doi: 10.1097/SLE.0b013e3181802ca7.
17. Flanagan NM, McAloon J. Gastric volvulus complicating cerebral palsy with kyphoscoliosis. Ulster Med J 2003; 72 (2): 118–120.
18. Kim HH, Park SJ, Park MI et al. Acute intrathoracic gastric volvulus due to diphragmatic hernia: a rare emergency easily overlooked. Case Rep Gastroenterol 2011; 5 (2): 272–277. doi: 10.1159/000328444.
19. Hána L, Kasalický M, Koblihová E et al. Urgentní chirurgické řešení valvulu žaludku při „upside-down stomach syndrome“. Rozhl Chir 2015; 94 (12): 531–534.
20. Chau B, Dufel S. Gastric volvulus. Emerg Med J 2007; 24 (6): 446–447. doi: 10.1136/emj.2006. 041947.
21. Naim HJ, Smith R, Gorecki PJ. Emergent laparoscopic reduction of acute gastric volvulus with anterior gastropexy. Surg Laparosc Endosc Percutan Tech 2003; 13 (6): 389–391.
22. Altintoprak F, Yalkin O, Dikicier E at al. A rare etiology of acute abdominal syndrom in adults: gastric vulvulus – cases series. Int J Surg Case Rep 2014; 5 (10): 731–734. doi: 10.1016/j.ijscr.2014.08.024.
23. Tsang TK, Walker R, Yu DJ. Endoscopic reduction of gastric volvulus: the alpha-loop maneuver. Gastrointest Endosc 1995; 42 (3): 244–248.
24. Zuiki T, Hosoya Y, Lefor AK et al. The management of gastric volvulus in elderly patients. Int J Surg Case Rep 2016; 29: 88–93. doi: 10.1016/j.ijscr.2016.10.058.
25. Eckhauser ML, Ferron JP. The use of dual percutaneous endoscopic gastrostomy (DPEG) in the management of chronic intermittent gastric volvulus. Gastrointest Endosc 1985; 31 (5): 340–342.
26. Jeong SH, Ha CY, Le YJ et al. Acute gastric volvulus treated with laparoscopic reduction and percutaneous endoscopic gastrostomy. J Korean Surg Soc 2013; 85 (1): 47–50. doi: 10.4174/jkss.2013.85.1.47.
27. Trastek VF, Allen MS, Deschamps C et al. Diaphragmatic hernia and associated anemia: response to surgical treatment. J Thorac Cardiovasc Surg 1996; 112 (5): 1340–1344. doi: 10.1016/S0022-5223 (96) 70149-6.
28. Weston AP. Hiatal hernia with Cameron ulcers and erosions. Gastrointest Endosc Clin  N Am 1996; 6 (4): 671–679.
29. Jensen DM, Machicado GA. Hemoclipping of chronic canine ulcers: a randomized, prospective study of initial deployment success, clip retention rates, and ulcer healing. Gastrointest Endosc 2009; 70 (5): 969–975. doi: 10.1016/j.gie.2009.04.052.
30. Camus M, Jensen DM, Ohning GV et al. Severe upper gastrointestinal hemorrhage from linear gastric ulcers in large hiatal hernias: a large prospective case series of Cameron ulcers. Endoscopy 2013; 45 (5): 397–400. doi: 10.1055/s-0032-1326294.

Credited self-teaching test