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Case 113: Vomiting and chest pain

A 74 year old woman presents with episodic chest pain, dysphagia and regurgitation of her saliva. A barium swallow is performed during her work up.

1. What is the abnormality?

There is a giant hiatus hernia with the entire stomach now in the chest. There is also organoaxial volvulus with the greater curvature now superior to the lesseer curvature

2. How can this problem be classified?

Hiatus hernia can be classified as:

Type I - A "sliding" hernia where the gastro-oesophageal junction rises into the chest
Type II - A "rolling" hernia where the gastro-oesophageal junction remains fixed but the fundus of the stomach rises into the chest beside the oesophagus
Type III - A mixed hernia with both type I and II components
Type IV - A large hernia with organs other than the stomach herniated into the chest

Volvulus is classified as organoaxial or mesoaxial (mesenteroaxial).