Severe Gastric Mucosal Necrosis Due to Giant Paraesophageal Hernia

Hiatal hernias occur when part of the intra-abdominal contents protrude into the chest cavity. Paraesophageal hernia (PEH) is a type of hiatal hernia that is chronic and usually asymptomatic. Although patients may not present with alarming symptoms, the complications of PEH may be severe if left untreated. Hiatal hernias can be further categorized based on the degree of herniation. The most common subtype is a type I hiatal hernia, which occurs when the gastroesophageal junction (GEJ) herniates into the chest cavity. Type II, III, and IV PEH are when the GEJ, a portion of the stomach, and abdominal viscera herniate into the thorax. A PEH is usually chronic and asymptomatic. However, patients may present with vomiting, dysphagia, bloating, and abdominal pain. Complications of PEH may include gastric mucosal necrosis, perforation, strangulation, erosive ulcers, and gastric volvulus. This report discusses a case of a 71-year-old male patient who had multiple complications arising from a large PEH that required emergent treatment due to its nebulous presentation.