A 55-year-old man with a Type III hiatal hernia (paraesophageal hernia) presents with postprandial chest pain and early satiety. What anatomical feature distinguishes a Type III from a Type II paraesophageal hernia?
- A Type III involves the gastric fundus herniated alongside the esophagus (GEJ in normal position + fundus herniated)
- B Type III has the entire stomach herniated through the diaphragm (intrathoracic stomach)
- C Type III is a mixed hernia where both the GEJ and gastric fundus herniate into the chest ✓
- D Type III refers to herniation of bowel through the hiatus
Explanation
Hiatal hernia classification: Type I (sliding) — GEJ above diaphragm, no true sac; Type II (true paraesophageal) — GEJ in normal position, only gastric fundus herniated alongside esophagus, true hernia sac present; Type III (mixed/combined) — both GEJ AND gastric fundus herniate, combining features of Types I and II; Type IV — other organs (omentum, colon, small bowel) herniate through the hiatus. Type III is the most common clinical paraesophageal hernia. Elective repair is recommended for symptomatic Type II–IV to prevent gastric volvulus, strangulation, or hemorrhage.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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