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Hiatal Hernia
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Hiatal hernia (HH)
        • Definitions

          • Protrusion of part of stomach through esophageal hiatus of diaphragm

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                Selected References

                                1. Kim J et al: Hiatal hernia prevalence and natural history on non-contrast CT in the multi-ethnic study of atherosclerosis (MESA). BMJ Open Gastroenterol. 8(1), 2021
                                2. Bader AS et al: Imaging in the evaluation of chest pain in the primary care setting, part 2: sources of noncardiac chest pain. Am J Med. 133(10):1135-42, 2020
                                3. Moten AS et al: In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation. Abdom Radiol (NY). 45(9):2656-62, 2020
                                4. Bell R et al: Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial. Gastrointest Endosc. 89(1):14-22.e1, 2019
                                5. Siegal SR et al: Modern diagnosis and treatment of hiatal hernias. Langenbecks Arch Surg. 402(8):1145-51, 2017
                                6. Duranceau A: Massive hiatal hernia: a review. Dis Esophagus. 29(4):350-66, 2016
                                7. D'Netto TJ et al: A technique for the laparoscopic repair of paraoesophageal hernia without mesh. J Gastrointest Surg. 18(4):851-7; discussion 857, 2014
                                8. Sheikh I et al: Consumer use of over-the-counter proton pump inhibitors in patients with gastroesophageal reflux disease. Am J Gastroenterol. 109(6):789-94, 2014
                                9. Dean C et al: Hiatal hernias. Surg Radiol Anat. 34(4):291-9, 2012
                                10. Nason KS et al: The laparoscopic approach to paraesophageal hernia repair. J Gastrointest Surg. 16(2):417-26, 2012
                                11. Belhocine K et al: Epidemiology of the complications of gastroesophageal reflux disease. Dig Dis. 27(1):7-13, 2009
                                12. Larusson HJ et al: Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity. World J Surg. 33(5):980-5, 2009
                                13. Yano F et al: Outcomes of surgical treatment of intrathoracic stomach. Dis Esophagus. 22(3):284-8, 2009
                                14. Granderath FA et al: Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg. 32(6):999-1007, 2008
                                15. Linke GR et al: Is a barium swallow complementary to endoscopy essential in the preoperative assessment of laparoscopic antireflux and hiatal hernia surgery? Surg Endosc. 22(1):96-100, 2008
                                16. Wykypiel H et al: Laparoscopic partial posterior (Toupet) fundoplication improves esophageal bolus propagation on scintigraphy. Surg Endosc. 22(8):1845-51, 2008
                                17. Huang SY et al: Large hiatal hernia with floppy fundus: clinical and radiographic findings. AJR Am J Roentgenol. 188(4):960-4, 2007
                                18. Rantanen TK et al: Gastroesophageal reflux disease as a cause of death is increasing: analysis of fatal cases after medical and surgical treatment. Am J Gastroenterol. 102(2):246-53, 2007
                                19. Zaninotto G et al: Long-term results (6-10 years) of laparoscopic fundoplication. J Gastrointest Surg. 11(9):1138-45, 2007
                                20. Canon CL et al: Surgical approach to gastroesophageal reflux disease: what the radiologist needs to know. Radiographics. 25(6):1485-99, 2005
                                21. Insko EK et al: Benign and malignant lesions of the stomach: evaluation of CT criteria for differentiation. Radiology. 228(1):166-71, 2003
                                22. Pierre AF et al: Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg. 74(6):1909-15; discussion 1915-6, 2002
                                23. Patti MG et al: Preoperative evaluation of patients with gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A. 11(6):327-31, 2001
                                24. Katkhouda N et al: Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery. 128(5):784-90, 2000
                                25. Luketich JD et al: Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg. 232(4):608-18, 2000
                                26. Schauer PR et al: Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg. 176(6):659-65, 1998
                                27. Maglinte DD et al: Radiologic features of carcinomas arising in hiatal hernias. AJR Am J Roentgenol. 166(4):789-94, 1996
                                28. Weston AP: Hiatal hernia with cameron ulcers and erosions. Gastrointest Endosc Clin N Am. 6(4):671-9, 1996
                                29. Vas W et al: Computed tomographic evaluation of paraesophageal hernia. Gastrointest Radiol. 14(4):291-4, 1989
                                30. Chen YM et al: Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: evaluation of the individual techniques. Gastrointest Radiol. 10(4):311-6, 1985
                                31. Pupols A et al: Hiatal hernia causing a cardia pseudomass on computed tomography. J Comput Assist Tomogr. 8(4):699-700, 1984
                                32. Cassel DM et al: Hiatus hernia causing CT gastric mass lesions. Comput Radiol. 7(3):177-9, 1983
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Imaging

                                  • Top Differential Diagnoses

                                    • Clinical Issues

                                      TERMINOLOGY

                                      • Abbreviations

                                        • Hiatal hernia (HH)
                                      • Definitions

                                        • Protrusion of part of stomach through esophageal hiatus of diaphragm

                                      IMAGING

                                      • General Features

                                        • Radiographic Findings

                                          • CT Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  • Staging, Grading, & Classification

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              Selected References

                                                              1. Kim J et al: Hiatal hernia prevalence and natural history on non-contrast CT in the multi-ethnic study of atherosclerosis (MESA). BMJ Open Gastroenterol. 8(1), 2021
                                                              2. Bader AS et al: Imaging in the evaluation of chest pain in the primary care setting, part 2: sources of noncardiac chest pain. Am J Med. 133(10):1135-42, 2020
                                                              3. Moten AS et al: In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation. Abdom Radiol (NY). 45(9):2656-62, 2020
                                                              4. Bell R et al: Laparoscopic magnetic sphincter augmentation versus double-dose proton pump inhibitors for management of moderate-to-severe regurgitation in GERD: a randomized controlled trial. Gastrointest Endosc. 89(1):14-22.e1, 2019
                                                              5. Siegal SR et al: Modern diagnosis and treatment of hiatal hernias. Langenbecks Arch Surg. 402(8):1145-51, 2017
                                                              6. Duranceau A: Massive hiatal hernia: a review. Dis Esophagus. 29(4):350-66, 2016
                                                              7. D'Netto TJ et al: A technique for the laparoscopic repair of paraoesophageal hernia without mesh. J Gastrointest Surg. 18(4):851-7; discussion 857, 2014
                                                              8. Sheikh I et al: Consumer use of over-the-counter proton pump inhibitors in patients with gastroesophageal reflux disease. Am J Gastroenterol. 109(6):789-94, 2014
                                                              9. Dean C et al: Hiatal hernias. Surg Radiol Anat. 34(4):291-9, 2012
                                                              10. Nason KS et al: The laparoscopic approach to paraesophageal hernia repair. J Gastrointest Surg. 16(2):417-26, 2012
                                                              11. Belhocine K et al: Epidemiology of the complications of gastroesophageal reflux disease. Dig Dis. 27(1):7-13, 2009
                                                              12. Larusson HJ et al: Predictive factors for morbidity and mortality in patients undergoing laparoscopic paraesophageal hernia repair: age, ASA score and operation type influence morbidity. World J Surg. 33(5):980-5, 2009
                                                              13. Yano F et al: Outcomes of surgical treatment of intrathoracic stomach. Dis Esophagus. 22(3):284-8, 2009
                                                              14. Granderath FA et al: Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg. 32(6):999-1007, 2008
                                                              15. Linke GR et al: Is a barium swallow complementary to endoscopy essential in the preoperative assessment of laparoscopic antireflux and hiatal hernia surgery? Surg Endosc. 22(1):96-100, 2008
                                                              16. Wykypiel H et al: Laparoscopic partial posterior (Toupet) fundoplication improves esophageal bolus propagation on scintigraphy. Surg Endosc. 22(8):1845-51, 2008
                                                              17. Huang SY et al: Large hiatal hernia with floppy fundus: clinical and radiographic findings. AJR Am J Roentgenol. 188(4):960-4, 2007
                                                              18. Rantanen TK et al: Gastroesophageal reflux disease as a cause of death is increasing: analysis of fatal cases after medical and surgical treatment. Am J Gastroenterol. 102(2):246-53, 2007
                                                              19. Zaninotto G et al: Long-term results (6-10 years) of laparoscopic fundoplication. J Gastrointest Surg. 11(9):1138-45, 2007
                                                              20. Canon CL et al: Surgical approach to gastroesophageal reflux disease: what the radiologist needs to know. Radiographics. 25(6):1485-99, 2005
                                                              21. Insko EK et al: Benign and malignant lesions of the stomach: evaluation of CT criteria for differentiation. Radiology. 228(1):166-71, 2003
                                                              22. Pierre AF et al: Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg. 74(6):1909-15; discussion 1915-6, 2002
                                                              23. Patti MG et al: Preoperative evaluation of patients with gastroesophageal reflux disease. J Laparoendosc Adv Surg Tech A. 11(6):327-31, 2001
                                                              24. Katkhouda N et al: Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery. 128(5):784-90, 2000
                                                              25. Luketich JD et al: Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg. 232(4):608-18, 2000
                                                              26. Schauer PR et al: Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg. 176(6):659-65, 1998
                                                              27. Maglinte DD et al: Radiologic features of carcinomas arising in hiatal hernias. AJR Am J Roentgenol. 166(4):789-94, 1996
                                                              28. Weston AP: Hiatal hernia with cameron ulcers and erosions. Gastrointest Endosc Clin N Am. 6(4):671-9, 1996
                                                              29. Vas W et al: Computed tomographic evaluation of paraesophageal hernia. Gastrointest Radiol. 14(4):291-4, 1989
                                                              30. Chen YM et al: Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: evaluation of the individual techniques. Gastrointest Radiol. 10(4):311-6, 1985
                                                              31. Pupols A et al: Hiatal hernia causing a cardia pseudomass on computed tomography. J Comput Assist Tomogr. 8(4):699-700, 1984
                                                              32. Cassel DM et al: Hiatus hernia causing CT gastric mass lesions. Comput Radiol. 7(3):177-9, 1983