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• W3209227680 abstract "Introduction: Lower gastrointestinal bleed (“GIB”) is a cause of GI hospital admissions, with an annual incidence of 36/100,000. Its bleeding that occurs after the ligament of Treitz. Some cases are life-threatening, and others are self-limiting. Hiatal hernia occurs when the upper part of the stomach bulges through the diaphragm. If small, patients (pt) are usually asymptomatic whereas large hernias present with severe symptoms. Case Description/Methods: 80 yo female with PMHX of HTN and Mallory Weiss tear presented with red blood per rectum for 4 hours. She denied NSAID or anticoagulation. Vitals: BP 60/38 mmHg and HR 101/min. PE: sick and pale appearance, bright red blood on rectal exam. Labs: HGB: 10.9 g/dl, platelet: 261mcl, BUN: 32mg/dl. A chest x-ray (cxr) showed large hiatal hernia partially obscuring the lungs (Figure 1). She was fluid resuscitated and intubated. CTA of the chest showed a large abdominal hernia extending into the thoracic cavity. Upper endoscopy (EGD) was done with caution and showed a large hiatal hernia and gastritis. Flexible sigmoidoscopy showed diverticulosis of the sigmoid colon and no rectal mass. Her bleeding resolved with conservative management. Discussion: Pts that present with symptoms of an upper or lower GIB have EGD and colonoscopy procedures done for diagnostic and/or therapeutic measures. Generally, EGD’s are safe, but not all are equal in complication risk. Common risk factors are organ perforation, nerve damage, bleeding, pneumothorax, and infection. Signs and symptoms that alert of complications are fever, chest pain, shortness of breath or vomiting.During an EGD, understanding GI anatomy is essential as pts can present differently and have post-surgical changes to their anatomy. Our pt had a large hiatal hernia, partially obscuring the left lung. As an endoscope or an NG tube is passed through the esophagus, there is a very high risk of perforating the bowels that are protruding into the chest cavity, or causing a pneumothorax, potentially causing catastrophic events. Perforation injury has a 20% mortality rate, requiring immediate surgical intervention, which should not be overlooked. Its important to get a CXR to visualize the field of study. Had we not gotten a chest x-ray, prior to EGD, the large hernia would not have been known, team would not have proceeded with extreme caution, and a perforation or pneumothorax could have resulted. This case highlights the importance of a CXR, prior to EGD, as it can be devastating if complicating anatomy is missed.Figure 1.: Large Hiatal Hernia." @default.
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• W3209227680 date "2021-10-01" @default.
• W3209227680 modified "2023-09-27" @default.
• W3209227680 title "S3583 A Case of a Complicating Diaphragmatic Hernia in a GI Bleeder" @default.
• W3209227680 doi "https://doi.org/10.14309/01.ajg.0000787864.77853.a4" @default.
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