S3579 Chest Pain Leading to the Diagnosis of an Uncomplicated Hiatal Hernia: A Case Report

INTRODUCTION: Hiatal hernia is a condition in which upper part of the stomach and abdominal viscera bulges through esophageal opening and diaphragm into the mediastinum. Chest pain is an uncommon presenting symptom which can confuse the diagnosis. CASE DESCRIPTION/METHODS: We present the case of an 81 year old woman with a history GERD, DVT, hypertension, hyperlipidemia and prior stroke who presented to our emergency department with chest pain. On arrival to the ED, her blood pressure was found to be elevated, 132/110 mmHg, pulse of 82 per minute, arterial oxygen saturation was reported as 100% on room air and she was a febrile. 325 mg of Aspirin and sublingual nitroglycerin was administered. The troponin and EKG did not reveal any abnormalities. Chest x ray was performed which revealed the presence of type IV or giant hernia. An EGD was done which revealed esophageal ulcerations, gastritis and the extent of the hernia. She was managed conservatively as she was deemed high risk for surgery. She was later discharged home on Pantoprazole and a surveillance endoscopy was recommended. DISCUSSION: Hiatal hernia is an uncommon diagnosis in the general population. It can present with a number of non specific symptoms or it can present with an acute complication. Almost 50% of the patients with hiatal hernia are asymptomatic. It is important to diagnose the hernia promptly, especially grade IV hernia which carries a significant risk of perforation.Figure 1.: CT Scan of the chest revealing the retro cardiac position of the stomach.