Hiatus hernia is herniation of abdominal viscera into the thoracic cavity through the oesophageal hiatus. Hiatus hernia is a rare condition in the paediatric age group, which may be asymptomatic or it may present with a variety of symptoms or complications.
There are four types of hiatus hernias:
Type I (sliding) hernia: Is the most common in which the gastro-oesophageal junction with a portion of stomach herniates into the thoracic cavity.
Type II (para-oesophageal) hernia: The gasto-oesophageal junction remains at or below the level of diaphragm and the gastric fundus herniates superiorly in a para-oesophageal location.
Type III hernia: is more common than Type II and has features of both Type I (sliding) and Type II (para-oesophageal) hernias.
Type IV hernia: All or part of the stomach herniates into the thorax, usually with organoaxial rotation of the stomach.
Hiatus hernia may be asymptomatic and diagnosed incidentally on routine chest radiographs or CT scans performed for unrelated symptoms. Symptoms of patients maybe epigastric pain, heartburn, nausea, vomiting and regurgitation.
Diagnosis is routinely done by Barium swallow examination, upper gastro-intestinal endoscopy and computed tomography.
Initial management includes medical and conservative management with Proton Pump Inhibitors (PPI). Patients who are refractory or have inadequate control with PPI therapy are considered for laparoscopic repair of the hiatus and Nissen fundoplication.