A case of Incarcerated Hiatal Hernia with multiple Gastric ulcers needed surgical approach

An 88 years old woman had suffered from vomiting and appetite loss from June 17, 2010. She was admitted to the hospital diagnosed with pneumonia by chest X-ray and blood test on 18. Endoscopy was performed after admission, because of black fluid drainaged from the Gastric tube. Endoscopic evaluation revealed multiple shallow ulcers in Stomach and Stomach deformity due to Hiatal Hernia which prevented from endoscopy insertion into duodenum. A computed tomography scan showed a severely incarcerated hiatal hernia involving dilated stomach due to obstruction. Reset trial by endoscopy was failed and surgical approach was chosen. The surgical findings showed massive incarceration of the stomach through the hiatal hernia orifice to the mediastinum. It was not easy to reduce the stomach from it, because of adhesion. As the reported mortality of perforated gastric ulcer associated with a hiatal hernia is high, early elective surgery should be performed in patients with incarcerated hiatal hernia especially with gastric ulcers that is resistant to acid-reducing regimen.