Practical Gastroenterology and Hepatology Board Review Toolkit

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


2.6 Dynamic computed tomography scan video of a large Type III hiatal hernia

A preoperative video esophagram of a patient with a large paraesophageal hernia. A nasogastric tube can be visualized coiled in the herniated stomach. Note that contrast flows without significant delay through the esophagus and gastroesophageal junction into a herniated stomach. The patient appears to have a Type III hiatal hernia as the gastroesophageal junction is located in the chest. Organoaxial volvulus is noted with minimal and delayed passage of contrast into the duodenum. There is a rounded intraluminal collection of contrast which represents a dependent portion of the fundus located in the hernia. Postoperative video esophagram in the same patient showing that the paraesophageal hernia has been reduced and the gastroesophageal junction is now in the correct anatomical position in the abdomen. A Nissen fundoplication is evident.