SHM Converge Scientific Abstract ePoster Gallery-Beware of Pancreatitis Secondary to Paraesophageal Herniation of the Pancreas

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This case report describes a 70-year-old woman with Barrett’s esophagus, class 3 obesity, atrial fibrillation, obstructive sleep apnea, and esophageal adenocarcinoma in remission who presented with three days of severe nausea, vomiting, and epigastric pain radiating to both upper quadrants. Examination showed epigastric tenderness, and labs revealed markedly elevated lipase (827), consistent with acute pancreatitis. CT imaging demonstrated mild inflammatory stranding around the pancreas and a large paraesophageal hernia containing the stomach, bowel loops, and a small portion of the pancreas, without necrosis or pseudocyst.<br /><br />The report highlights that paraesophageal hiatal hernias are uncommon, and pancreatic herniation is especially rare because the pancreas is normally retroperitoneal. When the pancreas herniates through the diaphragm, repetitive mechanical trauma and impaired blood supply may trigger pancreatitis. Diagnosis relies on clinical symptoms, elevated pancreatic enzymes, and CT evidence of both pancreatitis and transhiatal pancreatic herniation.<br /><br />Management depends on symptoms, stability, comorbidities, and patient preference. Asymptomatic or uncomplicated hernias may be treated conservatively, while symptomatic cases may require surgical repair after pancreatitis resolves. The authors emphasize the importance of maintaining a high index of suspicion for rare complications of paraesophageal hernias and recommend ongoing surgical follow-up.

Asset Subtitle

Nosheen Hafeez

Meta Tag

Author List Emily Enderlin, Fatima Khalid, Mohamed Boshnaf, Nosheen Hafeez, Sabri Elmansouri, Syed Hussaini

Category Clinical Vignettes

Concept Paraesophageal Hiatal Hernia

Concept Acute Pancreatitis

Concept Pancreatic Herniation

Concept Computed Tomography

Concept Diaphragmatic Defect

Distinguished Non-Finalist

Presenter Organization Baptist Health-Uams

Presenting Author Nosheen Hafeez

Track Adult

Keywords

acute pancreatitis

paraesophageal hernia

hiatal hernia

pancreatic herniation

Barrett’s esophagus

epigastric pain

elevated lipase

CT imaging

surgical repair

case report

Paraesophageal Hiatal Hernia

Acute Pancreatitis

Pancreatic Herniation

Computed Tomography

Diaphragmatic Defect