MASSIVE RIGHT-SIDED HIATAL HERNIA VARIATION: A Case Report

Background: A hiatal hernia describes a herniation of abdominal contents, typically the stomach, through the esophageal hiatus into the mediastinum. The majority of reported paraesophageal hernias (PEH) are left-sided; although, right-sided hiatal hernias have a better prognosis, there is little mention of them in current literature. Case Information: During a routine cadaver dissection for academic purposes, a massive hiatal hernia was identified in an 84-year-old female. This anatomic variant case presents with the abdominal contents of the entire stomach, pyloric sphincter, and portions of the greater and lesser omentums displaced into the right thoracic cavity. Such hernias can have acute symptoms, chronic symptoms, or present as asymptomatic. In this case report, the donor was thought to have no significant functional abnormalities, although there were reports of gastrointestinal bleeding. Conclusions: We believe this case to be a rare variant due to two factors: the size of the hiatus, and the displacement of the hernia into the right side of the mediastinum. The hiatal surface area (HSA) in this case report was calculated to be 17.41cm2, which is almost three times the established average HSA in normal patients. This case report attempts to add to the body of literature detailing right-sided hiatal hernias. Looking forward, we believe that there is great scope for future research specific to right-sided hiatal hernias and improvement in the quality of life for those who undergo elective PEH repair.