A hiatal hernia with paraesophageal herniation may develop a number of serious complications that can be life-threatening and which may require emergency surgery.


Potential complications:

(1) volvulus of the herniated tissue, with ischemic necrosis and perforation

(2) severe hemorrhage associated with mucosal ulceration

(3) respiratory compromise from the herniated organs

(4) aspiration pneumonia

(5) splenic infarction

(6) acute mediastinitis


Clinical findings suggesting a serious complication are the sudden onset of one or more of the following:

(1) deep central chest pain

(2) pleuritic pain

(3) shock, tachycardia or peripheral circulatory failure

(4) hemorrhage with hematemesis and/or melena

(5) acute dyspnea

(6) complete esophageal obstruction unrelieved by belching or vomiting


If respiratory compromise is associated with a herniated, air-filled stomach the passage of a nasogastric tube can provide relief until definitive surgery can be performed.


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