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Congenital para-oesophageal hiatus hernia: an interesting family history
  1. J E Rees,
  2. S Robertson,
  3. A W McNinch
  1. Department of Paediatrics, Royal Devon and Exeter Hospital, Exeter, Devon, UK
  1. Correspondence to:
 Miss J E Rees
 Department of Paediatrics, c/o Bramble Ward, Royal Devon and Exeter Hospital, Wonford Site, Bovemoor’s Lane, Exeter, Devon EX2 5DF, UK;

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True congenital para-oesophageal hiatus hernias are rare1; an intrathoracic gastric volvulus complicating such a hernia is rarer still although a well recognised paediatric surgical emergency. Rapid diagnosis and treatment is required to avoid gastric gangrene, perforation, or dilatation that can lead to cardiopulmonary arrest.2


A girl of 18 months presented to the emergency department in a collapsed state having vomited all liquids taken for 48 hours. The vomit was dark, stained with blood but not with bile, and was foul smelling. She had been irritable throughout the episode with obvious borborigmia and had not had a wet nappy for 24 hours.

Similar episodes of foul vomiting had occurred about every two weeks for the previous six months, each episode lasting four to five days before resolving spontaneously. During each episode the child was irritable, lethargic, passed less urine, and opened her bowels less frequently. No abdominal pain was apparent. There was no blood or mucus in her stools. She had presented to her general practitioner with each episode …

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