Bianca Varda, MD, Jake Jasurda, DO, Abdul Haseeb, MD Loyola University Medical Center, Maywood, IL
Introduction: Hiatal hernias (HH) affect anywhere from 10 to 50% of the adult population. Large and symptomatic hernias are often corrected surgically. Association of pancreatic injury with HH repair is rare. A PubMed search using the keywords “hiatal hernia + pancreas” yielded only 15 results. Here, we present a rare complication of hiatal hernia repair resulting in pancreatic injury and leak.
Case Description/Methods: A 58-year-old female withhypertension, acid reflux, , and a type III paraesophageal hernia presented to General Surgery clinic for evaluation of dysphagia, belching, and -bloating for several months. For a large symptomatic hiatal hernia, she underwent laparoscopic Nissen fundoplication. On post operative day (POD) 2, she developed hypoxia requiring intubation. CT chest demonstrated a large left pleural effusion extending across the midline of the abdomen with mass effect causing multifocal atelectasis.On POD 9, WBC count increased to 19.6 K/uL and she had intermittent fevers with a temperature of 38.8C. A left pigtail catheter was placed for the pleural effusion; amylase of the pleural fluid was elevated to 4,544 U/L. Repeat CT C/A/P showed peripancreatic stranding and fluid with a hypodense band within the pancreas concerning for focal injury and pancreatic leak. ERCP showed no brisk contrast extravasation, but due to a high clinical suspicion for pancreatic leak, sphincterotomy was performed and a flanged pancreatic duct stent was placed. Percutaneous drainage along with endoscopic pancreatic duct stent placement decreased the size of fluid collections and helped with the symptoms.
Discussion: Laparoscopic repair remains the treatment of choice for symptomatic hiatal hernias and is generally well-tolerated. Pancreatic injury and leak are rare complications associated with large hernia repairs. Gastroenterologists need to be aware of such presentations while following these patients during post operative period.
Figure: CT A/P demonstrating a large hiatal hernia.
Disclosures:
Bianca Varda indicated no relevant financial relationships.
Jake Jasurda indicated no relevant financial relationships.
Abdul Haseeb indicated no relevant financial relationships.
Bianca Varda, MD, Jake Jasurda, DO, Abdul Haseeb, MD. E0027 - A Rare Case of Paraesophageal Hernia Repair Complicated by Pancreatic Injury, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
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