Open AccessIntrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum: A case report and review of the literature
Author(s) -
Tarkan Jäger,
Daniel Neureiter,
C. Nawara,
Adam Dinnewitzer,
Dietmar Öfner,
Wolfram Lamadé
Publication year - 2013
Publication title -
world journal of gastrointestinal surgery
Language(s) - English
Resource type - Journals
ISSN - 1948-9366
DOI - 10.4240/wjgs.v5.i6.202
Subject(s) - medicine , duodenum , annular pancreas , major duodenal papilla , surgery , hiatal hernia , pancreas , general surgery , hernia , reflux , disease
Transhiatal herniation of the pancreas is an extremely rare condition. In the published literature we found only eleven cases reported in the period of 1958 to 2011. A coincidental hiatal herniation of the duodenum is described in two cases only. To our knowledge, we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis. A 72-year-old Caucasian woman was admitted to our department with a hiatal hernia grade IV for further evaluation. According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum, we had to respect the declared intention of the patient for a conservative procedure. So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition. We discuss the therapeutic decision making process and a complete literature review of this rare entity.