Two Cases of Congenital Paraesophageal Hiatal Hernia in Infancy

ABSTRACT

Herniation of the stomach through the esophageal hiatus into the posterior mediastinum is a commom affliction of humans. The incidence of hiatal hernia is difficult to determine because of the absence of symptoms in a large number of patients. Hiatal hernias are classified into two major types; type I sliding hiatal hernia and type II paraesophageal hiatal hernia. Sliding hernia is common, but paraesophageal hernia(PEH) is rare. Most PEH is demonstrated in elderly women. PEH in infancy is really rare. PEH is a true hernia, so it is a potentially life-threatening condition because of the risk of volvulus, incarceration, strangulation, and perforation. PEH is itself the indication for surgery. We experienced congenital PEH in two infants. One case was nearly asymptomatic, found incidentally by plain chest X-ray taken for pneumonia in a 12 month old female infant. She had no vomiting or reflux, but history of frequent feeding of small amount and often gurgling noise in her right chest. She had type IV PEH including herniation of the transverse colon. Another case was presented because of vomiting, and was diagnosed by ultrasonography initially in a 48 day old male infant. He had intrathoracic stomach, type III PEH with idiopathic hypertrophic pyloric stenosis and gastroesophageal reflux.