Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor


2.5 Esophagogastroduodenoscopy of a Type III paraesophageal hernia

A dynamic computed tomography (CT) scan video of a patient with a large Type III hiatal hernia. Points of note include: (1) the gastroesophageal junction and the pylorus are not located in the abdomen but have both migrated into the chest cavity; (2) the entire stomach has migrated into the chest, resulting in a so-called "intrathoracic stomach"; (3) the stomach appears to be volvulized, resulting in a mechanical gastric outlet obstruction as noted by the large amount of gastric contents in the obstructed stomach; and (4) there is no CT evidence of gastric wall ischemia or perforation.