Clinical introduction A 69-year-old woman presented to the ED with a chief complaint of recurrent vomiting for 3 weeks. She was afebrile, blood pressure was 100/67 mm Hg, HR was 114/min, RR was 19/min and oxygen saturation was 98%. On physical examination, she had mild epigastric tenderness without guarding. Blood tests were normal except for hyponatraemia of 128 mmol/L and hypokalaemia of 2.7 mmol/L. The ECG demonstrated sinus tachycardia with first-degree atrioventricular block. Chest radiograph posteroanterior view (CXR) was performed (figure 1).
Question Due to continuous vomiting of this patient, which of the following is the most appropriate management?
Chest and abdominal CT.
For answer see page 02
For question see page 01
- hiatal hernia
- paraesophageal hiatal hernia (PEH)
- chest radiograph
- computed tomography
- laparoscopic repair
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Contributors Y-KL reviewed the case and wrote the manuscript. C-LK contributed to the case and manuscript revision. C-WH contributed to manuscript review.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.