Sigmoid volvulus strangulation caused by a giant type IV hiatal hernia
DOI:
https://doi.org/10.18203/2349-2902.isj20252690Keywords:
Type IV hiatal hernia, Paraesophageal hernia, Giant hiatal hernia, Sigmoid volvulus, Hartmann’s procedure, Anterior gastropexyAbstract
A type IV hiatal hernia, characterized by the intrathoracic migration of abdominal viscera other than the stomach, is an uncommon and severe presentation of hiatal hernia. The resulting increase in intrathoracic pressure can cause a wide variety of symptoms on presentation and possibly lead to misdiagnosis. The colon, most often the transverse segment, is one of the organs that can be involved, leading to potentially life-threatening complications like volvulus, incarceration and strangulation. Of these, the strangulation of a synchronous sigmoid volvulus is extremely rare and requires prompt intervention. We report herein a 90-year-old woman who presented to the emergency department with a multitude of gastrointestinal and respiratory acute-onset symptoms. Imaging revealed a rare type IV hiatal hernia containing the entire stomach and the apex of a sigmoid volvulus. An emergency laparotomy was performed, in which the sigmoid volvulus was identified as partially incarcerated and strangulated within the giant paraesophageal hernia. The patient underwent a life-saving sigmoid colon resection and anterior gastropexy. To our knowledge, this is the first report of such a rare association between these two life-threatening and usually separated entities-a sigmoid volvulus strangulated within a giant type IV hiatal hernia. Recognizing the several possible scenarios of clinical presentation in complex type IV hiatal hernias is extremely important as early detection and immediate treatment are essential in reducing morbidity and mortality associated with this challenging condition. Computed tomography of the chest and abdomen is considered the gold standard in the diagnosis of both entities.
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References
Ke M. Hernias and volvulus of the gastrointestinal tract. In: Felman M, Scharschmidt B F, Sleisenger M H, Klein S, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. Philadelphia, PA: W.B. Saunders. 1998;318-27.
Patel S, Yarra S, Owji S, Benavidez JE, Nguyen QD. Minding the Gap: Clinical Manifestations of a Rare Type IV Hiatal Hernia. Cureus. 2020;12(7):e9275. DOI: https://doi.org/10.7759/cureus.9275
Kohn GP, Price RR, Demeester SR, Zehetner J, Muensterer OJ, Awad ZT, et al. Guidelines for the Management of Hiatal Hernia. Surg Endosc. 2013;27:4409-28. DOI: https://doi.org/10.1007/s00464-013-3173-3
Giuffrida M, Perrone G, Abu-Zidan F, Agnoletti V, Ansaloni L, Baiocchi GL, et al. Management of complicated diaphragmatic hernia in the accute setting: a WSES position paper. World J Emerg Surg. 2023;18(1):43. DOI: https://doi.org/10.1186/s13017-023-00510-x
Society of American Gastrointestinal and Endoscopic Surgeons: Guidelines for the Surgical Treatment of Hiatal Hernias, 2024. Available at: https://www.sages.org/publications/guidelines/guidelines-for-the-surgical-treatment-of-hiatal-hernias. Accessed on 7 march 2025.
Ferrer Ocampo LM, Lin J, Donnatien L, Singh G, Lincer R. Sigmoid Volvulus in the Setting of Type 4 Hiatal Hernia: An Uncommon Presentation and Literatute Review. Cureus. 2024;16(4):e63595. DOI: https://doi.org/10.7759/cureus.63595
Krause W, Roberts J, Garcia-Montilla RJ. Bowel in Chest: Type IV Hiatal Hernia. Clin Med Res. 2016;14(2):93-96. DOI: https://doi.org/10.3121/cmr.2016.1332
Grushka JR, Grenon SM, Ferri LE. A type IV paraesophageal hernia containing a volvulized sigmoid colon. Dis Esophagus. 2008;21:94-96. DOI: https://doi.org/10.1111/j.1442-2050.2007.00751.x
Vega Jr. JA, Velanovich V. Paraesophageal Hernia: Etiology, Presentation, and Indications for Repair. In: Yeo CJ, DeMeester SR, McFadden DW, Matthews JB, Fleshman JW. Shackelford’s surgery of the alimentary tract. 8th ed. Philadelphia, PA: Elsevier; 2019;279-83. DOI: https://doi.org/10.1016/B978-0-323-40232-3.00025-X
Wells K. Colonic Intussusception and Volvulus. In: Yeo CJ, DeMeester SR, McFadden DW, Matthews JB, Fleshman JW. Shackelford’s surgery of the alimentary tract. 8th ed. Philadelphia, PA: Elsevier. 2019;1807-13. DOI: https://doi.org/10.1016/B978-0-323-40232-3.00155-2
Tian BWCA, Vigutto G, Tan E, van Goor H, Bendinelli C, Abu-Zidan F, et al. WSES consensus guidelines on sigmoid volvulus management. World J Emerg Surg. 2023;18(1):34. DOI: https://doi.org/10.1186/s13017-023-00502-x
Yildiz SY, Berkem H, Yuksel BC, Ozel H, Hengirmen S. Isolated Intrathoracic Hiatal Herniation of the Twisted Sigmoid Colon: Report of a Case. Dis Colon Rectum. 2009;52:740-1. DOI: https://doi.org/10.1007/DCR.0b013e318199dbe6
Ballantyne GH, Brandner MD, Beart RW Jr, Ilstrup DM. Volvulus of the colon. Incidence and mortality. Ann Surg. 1985;202(1):83-92. DOI: https://doi.org/10.1097/00000658-198507000-00014
Atamanalp SS, Disci E, Peksoz R. Sigmoid volvulus and concomitant clinical entities. Formosan J Surg. 2024;57(3):87-92. DOI: https://doi.org/10.1097/FS9.0000000000000132
Raveenthiran V, Madiba TE, Atamanalp SS, De U. Volvulus of the sigmoid colon. Colorectal Dis. 2010;12(7):e1-17. DOI: https://doi.org/10.1111/j.1463-1318.2010.02262.x
Ayyildiz VA, Ozgokce M, Turkoglu S, Dundar I, Durmaz F, Ozkaçmaz S, et al. Radiological appearance of hiatal hernias on computed tomography. East J Med. 2002;27:11-5. DOI: https://doi.org/10.5505/ejm.2022.33341
Levsky JM, Den EI, DuBrow RA, Wolf EL, Rozenblit AM. CT findings of sigmoid volvulus. AJR Am J Roentgenol. 2010;194(1):136-43. DOI: https://doi.org/10.2214/AJR.09.2580
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