Hi Gang,

Rare – but can be deadly.

The MQA committee requested I remind ED docs about this diagnosis. We have had two cases at South Muskoka ( known about) in just over the last year. Both patients died at home within hours of being in the emergency room. One in her 90’s and one in her 70’s.

In doing a literature search I really can’t find very consistent incidence rates….however…this is just a reminder to consider this diagnosis….

I thought this little snip from a case report was easy and helpful…

“Even though incarcerated hiatus hernias are rare, it is important to consider them as a differential diagnosis for many surgical and medical presentations. The consequence of a delayed or missed diagnosis may be disastrous and the possible alternatives can be equally as important. These include acute coronary syndromes, acute respiratory pathology, intestinal perforation, aortic rupture or dissection and pancreatitis. Chest X-ray can provide clues such as left sided pulmonary effusion, visible large hernia above the diaphragm and pneumoperitoneum or mediastinum . Given the potential heterogeneity in both the presentation and interpretation of the assessing physician, liaising of both medical and surgical specialities is paramount. Traditionally an emergency laparotomy is performed but hiatus hernias are more frequently repaired electively and as an emergency through laparoscopic techniques .”

I think it will be for us to think about and diagnose ,or suggest to consider, to our specialist peers. Just my thoughts though.

John