Dysphagia and Dyspnea

A 62-year-old man with a large hiatus hernia underwent Dor fundoplication with posterior hiatoplasty in 2018. In the spring of 2021 he presented with worsening loss of appetite, describing a feeling of satiety, difficulty in swallowing, recurring regurgitation, and increasing shortness of breath over the past few weeks. On physical examination there were bowel sounds rather than breathing sounds on the right side of the chest. Computed tomography showed complete enterothorax with gastric volvulus and prolapse of large and small bowel into the thoracic cavity. The hernial content was repositioned laparoscopically and the large diaphragmatic hernia was closed with mesh. The patient was discharged free of symptoms 5 days later. A cardiological and pneumological work-up had been carried out in 2020 after the patient experienced stress dyspnea. The clinical picture of enterothorax may already have been emerging at that time. So-called type IV hiatus hernias are extremely rare and typically occur as a consequence of surgical or traumatic injury of the diaphragm, e.g., after reflux operations. This case is an example of the extreme event of enterothorax developing from a hiatus hernia.

Dr. med. Carlo Schneider, Patricia Faßbender, Refluxzentrum am evangelischen Klinikum Köln Weyertal, Innere Medizin, EVK Köln Weyertal, carlo. [e-mail]
Prof. Dr. med. Jessica Leers, Refluxzentrum am evangelischen Klinikum Köln Weyertal, Spezielle Viszeralmedizin und funktionelle Chirurgie des oberen Gastrointestinaltrakts, EVK Köln Weyertal

Conflict of interest statement: Dr. Schneider has received lecture fees from Falk. The other authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Schneider C, Fassbender P, Leers J: Dysphagia and dyspnea. Dtsch Arztebl Int 2022; 119: 341. DOI: 10.3238/arztebl.m2022.0055