1
|
Miyagishima D, Yoshida M, Yamada N, Kinjo K, Fujita N, Suzuki H, Sugimura K, Kubota M, Nakagawa A, Kikuchi Y, Shinozaki M. Hiatal Hernia with Prolapse of the Pancreas Causing Bile Duct Stricture and Liver Function Disorders: A Case Report and Literature Review. Intern Med 2022; 62:1473-1478. [PMID: 36198599 DOI: 10.2169/internalmedicine.0537-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hiatal hernia is a common condition in elderly patients, but the additional presence of prolapse of the pancreas is extremely rare. We herein report an 89-year-old woman who presented with liver function disorders and abdominal pain. Her laboratory tests revealed cholestasis, and imaging examinations showed stenosis of the common bile duct pulled toward the hernia sac. She was diagnosed with a common bile duct stricture due to pancreatic herniation and underwent laparoscopic surgery. Our review of the literature identified three types of pancreatic herniations: asymptomatic, bile duct complication, and acute pancreatitis. Pancreatic head herniation tends to induce bile duct complications.
Collapse
Affiliation(s)
- Daisuke Miyagishima
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Masakatsu Yoshida
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Nobuhiro Yamada
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kaori Kinjo
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Naoto Fujita
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Hiromasa Suzuki
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Kaoru Sugimura
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Michio Kubota
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Akihiko Nakagawa
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Yasuharu Kikuchi
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| | - Masami Shinozaki
- Department of Gastroenterology and Hepatology, Numazu Municipal Hospital, Japan
| |
Collapse
|
2
|
Karan A, Kiamos A, Stack A, Gharia B. Pancreatic herniation: a large pancreatic mass concealed within the intrathoracic cavity. BMJ Case Rep 2022; 15:e251039. [PMID: 35878967 PMCID: PMC9328086 DOI: 10.1136/bcr-2022-251039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2022] [Indexed: 11/03/2022] Open
Abstract
Cancer of unknown primary is a challenging entity. We present an elderly woman with metastatic cancer of unknown primary despite comprehensive imaging and immunohistochemical analysis. Based on a thorough history, a gastrointestinal source was suspected and a diagnosis of pancreatic cancer concealed within a type IV hiatal hernia was made using multimodal imaging. On review of prior imaging, due to the highly complex anatomy within our patient's hiatal hernia, the pancreatic mass was retroactively noted. While initial imaging may detect metastatic disease, identifying the primary malignancy requires a thorough history and physical examination, multimodal imaging where malignancy is suspected, and immunohistochemical analysis of metastatic deposits. Herniation of pancreatic cancer has not been previously described in the literature and serves as an important reminder of the importance of multimodal imaging in patients with significantly complex anatomy.
Collapse
Affiliation(s)
- Abhinav Karan
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Amy Kiamos
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Anthony Stack
- Hematology and Oncology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Bharatsinh Gharia
- Hematology and Oncology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| |
Collapse
|
3
|
Yoneda A, Murakami S, Tetsuo H, Fukui S, Miyoshi T, Okamoto T, Kitasato A, Takeshita H, Kuroki T. Application of laparoscopic distal pancreatectomy for normal anatomy after hiatal hernia repair: A case report. Clin Case Rep 2022; 10:e05832. [PMID: 35592041 PMCID: PMC9097373 DOI: 10.1002/ccr3.5832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/23/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
We describe a case of pancreatic tumor associated with a giant type IV hiatal hernia that had prolapsed into the posterior mediastinum. Hiatal hernia repair should be performed first because it enables laparoscopic distal pancreatectomy to be performed in the normal anatomical position.
Collapse
Affiliation(s)
- Akira Yoneda
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Shunsuke Murakami
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Hanako Tetsuo
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Saeko Fukui
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Takayuki Miyoshi
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Tatsuya Okamoto
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Amane Kitasato
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Hiroaki Takeshita
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| | - Tamotsu Kuroki
- Department of SurgeryNational Hospital Organization Nagasaki Medical CenterOmuraJapan
| |
Collapse
|
4
|
Tolboom RC, Wijsman PJ, Broeders I, Draaisma WA. Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature. Cureus 2020; 12:e7125. [PMID: 32257671 PMCID: PMC7105072 DOI: 10.7759/cureus.7125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Transhiatal herniation of the pancreas is rare with only 17 cases reported in 25 years. Presentation of pancreatic herniation is diverse. In the majority of cases, the pancreatic herniation is found incidentally on CT-scans made for evaluating complaints related to a large or giant hiatal hernia. We present a literature review and case series of three patients with symptomatic type IV hiatal hernia with incidental, asymptomatic pancreatic herniation. All cases were managed laparoscopically with robotic assistance.
Collapse
Affiliation(s)
- Robert C Tolboom
- Surgery, Meander Medical Center, Amersfoort, NLD.,Anesthesiology, Radboud University Medical Center (Radboudumc), Nijmegen, NLD.,Robotics and Mechatronics, University of Twente, Enschede, NLD
| | | | - Ivo Broeders
- Surgery, Meander Medical Center, Amersfoort, NLD
| | | |
Collapse
|
5
|
Rudman HA, Stott MC, Loh MY, Clark EC. Rectal varices due to chronic inferior mesenteric vein thrombosis caused by external compression in a large hiatus hernia containing the pancreas. Ann R Coll Surg Engl 2018; 100:e171-e173. [PMID: 29909661 DOI: 10.1308/rcsann.2018.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 79-year-old woman presented with a large fresh rectal bleed. Computed tomography revealed that she had a large type IV hiatus hernia, which contained the stomach and pancreas. Compression of the inferior mesenteric vein and splenic vein had led to thrombosis within these vessels and retrograde flow within the inferior mesenteric vein. This had led to the formation of portosystemic rectal varices. Ectopic varices occasionally form in the rectum, often in the context of liver cirrhosis. At the time of writing, ours is the first reported case of portosystemic rectal varices formulated in response to obstruction of vessels within a hiatus hernia.
Collapse
Affiliation(s)
- H A Rudman
- Department of General Surgery, Stepping Hill Hospital , Stockport , UK
| | - M C Stott
- Department of General Surgery, Stepping Hill Hospital , Stockport , UK
| | - M Y Loh
- Department of Radiology, Stepping Hill Hospital , Stockport , UK
| | - E C Clark
- Department of General Surgery, Stepping Hill Hospital , Stockport , UK
| |
Collapse
|
6
|
Goyal VD, Sharma S, Mahajan S, Kumar A. Transthoracic repair of paraesophageal diaphragmatic hernia presenting with symptoms mimicking cardiac disease (chest pain and breathlessness). J Clin Diagn Res 2014; 8:ND20-1. [PMID: 25478401 DOI: 10.7860/jcdr/2014/10261.5007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/13/2014] [Indexed: 11/24/2022]
Abstract
We discuss a case of 60-year-old female patient, who presented with history of chest pain radiating to left shoulder, breathlessness and postprandial discomfort. Patient was initially suspected to be suffering from cardiac pathology and was evaluated accordingly. Upper gastrointestinal endoscopy also missed the findings of paraesophageal hernia as the gastroesophageal junction was at its normal position. Chest roentgenogram raised the suspicion of diaphragmatic hernia, computed tomogram of chest and abdomen was done later on and showed characteristic features of paraesophageal hernia. Patient underwent transthoracic repair of the paraesophageal hernia along with partial fundoplication and had complete relief from the symptoms after surgery.
Collapse
Affiliation(s)
- Vikas Deep Goyal
- Assistant Professor, Department of Cardiothoracic and Vascular Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| | - Sanjeev Sharma
- Professor, Department of Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| | - Som Mahajan
- Assistant Professor, Department of Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| | - Ashwani Kumar
- Junior Resident, Department of Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| |
Collapse
|
7
|
Alam N, Zeidan S, Lamparelli M. A rare case of umbilical hernia containing the pancreas. J Surg Case Rep 2014; 2014:rju006. [PMID: 24876371 PMCID: PMC4164196 DOI: 10.1093/jscr/rju006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We present an extremely rare case of anterior abdominal wall hernia containing multiple viscera and the pancreas in a morbidly obese patient.
Collapse
Affiliation(s)
- Nasra Alam
- Department of Surgery, Torbay Hospital, Torquay, UK
| | - Shady Zeidan
- Department of Surgery, Derriford Hospital, Plymouth, Devon, UK
| | | |
Collapse
|
8
|
Kumar P, Turp M, Fellows S, Ellis J. Pancreatic herniation: a rare cause of acute pancreatitis? BMJ Case Rep 2013; 2013:bcr2013201979. [PMID: 24343805 PMCID: PMC3888546 DOI: 10.1136/bcr-2013-201979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acute pancreatitis is a common and potentially fatal condition, with several well-known causes including gallstones, excessive alcohol consumption and specific medications. We report a case of an 89-year-old man presenting with acute pancreatitis, which we believe to be secondary to a diaphragmatic herniation of the pancreas. This extremely rare anatomical abnormality can be found incidentally in the asymptomatic patient or may present with a variety of acute symptoms. However, there have been only isolated reports of these cases presenting as acute pancreatitis. While the majority of acute pancreatitis cases can be explained by common causes, it is important that clinicians be aware of and should consider investigating for other more unusual possibilities, such as pancreatic herniation, before labelling an episode as 'idiopathic'.
Collapse
Affiliation(s)
- Prashant Kumar
- Department of Surgery, Milton Keynes General Hospital, Milton Keynes, Bucks, UK
| | - Matthew Turp
- Department of Surgery, Milton Keynes General Hospital, Milton Keynes, Bucks, UK
| | - Sarah Fellows
- Department of Surgery, Milton Keynes General Hospital, Milton Keynes, Bucks, UK
| | - Jonathan Ellis
- Department of Radiology, Milton Keynes General Hospital, Milton Keynes, Bucks, UK
| |
Collapse
|
9
|
Jäger T, Neureiter D, Nawara C, Dinnewitzer A, Öfner D, Lamadé W. Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature. World J Gastrointest Surg 2013; 5:202-206. [PMID: 23805366 PMCID: PMC3692958 DOI: 10.4240/wjgs.v5.i6.202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 04/09/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity.
Collapse
|
10
|
Valente T, Rossi G, Lassandro F, Rea G, Muto M. Asymptomatic isolated partial hiatal herniation of the pancreas: MDCT evaluation and anatomical explanation: case report and review of literature. Clin Anat 2013; 26:1008-13. [PMID: 23553966 DOI: 10.1002/ca.22240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/17/2013] [Indexed: 12/15/2022]
Abstract
Isolated herniation of the pancreas through a gastroesophageal hiatus is an extremely rare condition, and only one case has been reported in the world literature. We describe a MDCT diagnosis of isolated partial hiatal hernia containing the body of a normal pancreas in an asymptomatic patient, give an anatomical explanation and review the corresponding literature.
Collapse
Affiliation(s)
- Tullio Valente
- Department of Radiology, Ospedali dei Colli, P.O. Monaldi, 80131, Naples, Italy
| | | | | | | | | |
Collapse
|