A 68-year-old obese woman presents with heartburn, regurgitation, and nocturnal aspiration symptoms. Barium swallow reveals a large portion of the stomach herniating into the posterior mediastinum alongside a normally positioned gastroesophageal junction. Which type of hiatal hernia does this describe?

• A Type III (mixed) hiatal hernia ✓
• B Type II (paraesophageal) hiatal hernia
• C Type I (sliding) hiatal hernia
• D Type IV hiatal hernia

Explanation

Type III (mixed) hiatal hernia has both features: the gastroesophageal junction migrates above the diaphragm (sliding component) AND a large portion of the fundus herniates alongside it (paraesophageal component). In Type I (sliding), the GEJ moves up but the fundus remains subdiaphragmatic. In Type II (true paraesophageal), the GEJ remains in normal position while the fundus herniates. Type IV involves other organs (colon, spleen) in the hernia sac.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.