A 65-year-old woman undergoes CT for unrelated complaints, revealing a large type II (rolling) paraoesophageal hiatus hernia with the fundus displaced into the chest. She has only mild heartburn and is otherwise well. Why is elective surgical repair generally advised?

• A The hernia will inevitably progress to achalasia
• B It carries a high annual rate of malignant transformation
• C Risk of gastric volvulus with strangulation and necrosis ✓
• D It always produces severe dysphagia requiring urgent surgery

Explanation

In a rolling paraoesophageal hernia the gastro-oesophageal junction remains intra-abdominal, so reflux symptoms are often mild. The danger is that a large portion of stomach sits above the diaphragm where it can rotate, causing organoaxial volvulus, incarceration, strangulation, gangrene, and haemorrhage. Because these events carry high mortality, repair is advised even when asymptomatic. The other options describe complications of sliding hernia or conditions unrelated to this anatomy.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.