Esofagitis crónica en paciente con hernia hiatal recidivante de 10 años de evolución: a propósito de un caso

Abstract

A hiatal hernia describes an enlarged diaphragmatic esophageal hiatus, through which partial or total prolapse of the stomach is produced. Sometimes the prolapse occurs along with other intra-abdominal organs into the chest cavity. It has been related with patients diagnosed by endoscopy with esophagitis. The prevalence of this type of hernia is up to 90%. Its etiology is multifactorial and not so specific. Its diagnosis is based on the patient's symptoms and complementary studies. They include, being highlighted, the upper digestive endoscopy, the esophagogram and the esophageal manometry. The treatment of choice is laparoscopic surgery. The case of a 67-year-old female patient with a history of hiatal hernia that caused gastroesophageal reflux was presented, for which a Nissen gastric fundoplication was performed 21 years ago. She was admitted into the Internal Medicine service 10 years ago for suffering from dysphagia for solid foods, epigastralgia, heartburn and regurgitation. She was evaluated by the Gastroenterology service on several occasions indicating medical therapy for symptoms, without improvement of the clinical picture. Upper gastrointestinal endoscopy, esophagogram and high-resolution esophageal manometry were performed, reporting a large recurrent hiatal hernia and a failed fundoplication that led to the development of severe chronic esophagitis. With this diagnosis, she was evaluated by the General Surgery service for surgical management. Hiatoplasty and laparoscopic Nissen fundoplication were perfomed without complications. A bibliographical review of scientific articles and clinical cases was carried out in databases such as Medline, UpToDate, Intra Med, PubMed, Cochrane, SciELO, Elsevier, Springer and other journals with good scientific evidence with a maximum date limit of 10 years ago. They provide relevant information and data for the development and analysis of the clinical case. A recurrent hiatal hernia is a frequent complication after surgical intervention, observed in 15%-60% of cases, generating complications and repercussions on the quality of life of patients.