Incarcerated Type Ⅲ Hiatal Hernia Complicated by Esophageal Obstruction with Transient Intussusception: Report of a Case

食道裂孔赫尼亞經常引發胃食道逆流，而肇因於箝閉性裂孔赫尼亞且引發短暫性胃食道套疊的情況極為罕見。在此，我們報告一位八十五歲女性病患，過去曾患有食道裂孔赫尼亞，而且引發嚴重的胃食道逆流，因突發上腹不適以及吞嚥困難而到急診就醫。其胃鏡檢查發現下食道完全阻塞，超音波縱婦描發現在心窩部有雙層腸壁影像疑似有腸管套疊，胸部電腦斷層也顯示有典型的同心圓像。於是進行剖腹探查，結果發現為箝閉性第三型傍食道裂孔赫尼亞，經手術修復之後，患者復元良好。所以當老年病患有胃食道逆流的症狀時，要特別注意是否已經產生箝閉性食道裂孔赫尼亞，我們可以先給予密切注意和藥物治療，一旦發生吞嚥困難以及食道完全阻塞時，則求助於外科手術是必要的。

關鍵字

裂孔赫尼亞；食道阻塞；腸套疊

並列摘要

Hiatal hernia is commonly existed in the subjects with gastro-esophageal reflux disease, however, an incarcerated hiatal hernia leading to obstruction looks very unusual. Here, we report an 85-year-old female with a hiatal hernia and severe acid regurgitation. She came to the emergency room with acute onset of dysphagia and upper abdominal discomfort. Endoscopy showed complete esophageal obstruction about 30 cm from the incisors. Ultrasonography conducted in the sagittal body plane through the diaphragmatic hiatus showed double alimentary tract walls suggestive of intussusception. Chest computed tomography (CT) with contrast revealed a soft tissue mass with a target appearance compatible with intussusception. After emergency laparotomy, a mixed type herniation was found and the diaphragma tic defect was repaired. The patient had an uneventful recovery. In elderly people with long-term acid reflux disease, simple observation combined with medical treatment is a reasonable course of action. However, if sudden onset of dysphagia or complete esophageal obstruction is present, incarcerated hiatal hernia should be kept in mind, surgery is mandatory.

並列關鍵字

hiatal hernia ； esophageal obstruction ； intussusception

國際替代計量

Incarcerated Type Ⅲ Hiatal Hernia Complicated by Esophageal Obstruction with Transient Intussusception: Report of a Case

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