Rare patient with diaphragmatic hernia discovered at Cua Dong General Hospital

Mrs. L. is 77 years old this year, a bit fat but quite agile and active. She came for a check-up athospitalin a state of dizziness. This unpleasant feeling she has been experiencing for about 2 weeks now.

Based on the X-ray results of patient L., the doctor discovered that the patient had a diaphragmatic hernia.

At the clinic, her blood pressure was measured at 190/100mmHg, heart rate was 88 beats/minute, normal heart sounds, normal breathing, no pathological rales in the lungs, and a soft abdomen with no pain. Her dizziness and lightheadedness were diagnosed as grade III, stage I hypertension.

In addition, the test results showed increased white blood cell count, increased liver enzymes and blood lipids, chest X-ray film showed an air-fluid level behind the heart (positive Felson sign), lateral X-ray showed an air-fluid level behind the heart, covering the space behind the heart (positive Felson sign); CT scan showed a part of the stomach had penetrated the diaphragm into the chest cavity. The patient was diagnosed with esophageal hiatal hernia (diaphragmatic hernia).

Associate Professor, Doctor, Doctor of Internal Medicine, Ha Hoang Kiem has discovered many rare cases of diseases, belonging to specialized fields; lower-level hospitals have difficulty detecting and diagnosing them. Photo: Cao Phuong

According to Associate Professor, Dr. Ha Hoang Kiem, diaphragmatic hernia is a condition in which part of the stomach or part of the abdominal organs escapes through the diaphragmatic opening, located in the chest. There are two types of the disease, congenital and acquired. Acquired diaphragmatic hernia, also known as esophageal hiatal hernia, is common in patients over 40 years old, the older the age, the higher the incidence and is more common in women and obese people.

Clinical symptoms of acquired hiatal hernia are almost non-existent, only patients with complications of esophageal reflux can have symptoms of gastric syndrome (accounting for only about 20-30%). Therefore, the disease is often not detected or accidentally detected when going for examination due to other diseases.

Consequences of acquired diaphragmatic hernia can include: Esophagitis, esophageal erosion (Cameron ulcer), bleeding from inflammatory lesions or esophageal ulcers, dysplasia, esophageal cancer, and in some cases, gastric torsion on the diaphragm can occur, which is a surgical emergency.

The patient may have no symptoms, or have different symptoms depending on the level of impact on the digestive or respiratory organs; there may be heartburn, belching or difficulty swallowing, chest pain, severe abdominal pain, nausea, vomiting, symptoms of lower or upper intestinal obstruction, difficulty breathing... Therefore, the disease is likely to be missed or misdiagnosed with some diseases such as stomach ulcers, digestive disorders, angina... Most patients with diaphragmatic hernia do not have any uncomfortable symptoms and do not need treatment, however, if heartburn and acid reflux are frequent, the doctor needs to prescribe medication or surgery.

Associate Professor, Dr. Ha Hoang Kiem is currently examining and treating directly at the Professor's Clinic, Cua Dong General Hospital. Photo: Cao Phuong

To prevent diaphragmatic hernia, Associate Professor, Dr. Ha Hoang Kiem recommends: People need to have a regular lifestyle and diet to avoid obesity, constipation, avoid increasing abdominal pressure, maintain physical activity, exercise, and have regular health check-ups every 6 months; to promptly detect asymptomatic cases./.