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Hiatal Hernia

Matthew J Kor, MD Reviewed 05/2023
 


BASICS

The herniation or superior displacement of abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity. 

DESCRIPTION

  • Hiatal hernias are divided into sliding (Type I) ...

DIAGNOSIS

HISTORY

  • All types

    • Often asymptomatic

    • Gastroesophageal reflux (e.g., heartburn, regurgitation, dysphagia)

    • Iron-deficiency anemia

  • Paraesophageal (Type II–IV)

    • Postprandial f...

TREATMENT

GENERAL MEASURES

  • Avoid trigger foods (e.g., alcohol, coffee, chocolate, carbonate beverages, onions, garlic, tomatoes, citrus, fatty foods, and spicy foods) (4)[A].

  • Weight management

  • Tobacco c...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Ensure follow up with surgery for elective repair of symptomatic paraesophageal hernias (assuming no acute complication) if patient is a suitable candidate.

  • Repair...

REFERENCES

1
Smith RE, Shahjehan RD. Hiatal hernia. StatPearls [Internet]. StatPearls Publishing, 2022.
2
Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. M...

ADDITIONAL READING

Laxague F, Sadava EE, Herbella F, et al. When should we use mesh in laparoscopic hiatal hernia repair? A systematic review. Dis Esophagus. 2021;34(6):doaa125. d...

CODES

ICD10

  • K44.1 Diaphragmatic hernia with gangrene

  • K44 Diaphragmatic hernia

  • Q40.1 Congenital hiatus hernia

  • K44.0 Diaphragmatic hernia with obstruction, without gangrene

  • K44.9 Diaphragmatic hernia without...

CLINICAL PEARLS

  • Hiatal hernias are often incidentally noted on imaging.

  • A retrocardiac air-fluid level is pathognomonic for paraesophageal hiatal hernia.

  • Asymptomatic hiatal hernias may not require any ...

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