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Abstract: Intra-abdominal hernia includes both primary and secondary types, which may cause serious consequences if not diagnosed and treated in time, and esophageal hiatal hernia is one type of intra-abdominal hernia. In this case, a male patient, 62 years old, complained of acid reflux and heartburn for more than 3 months, and came to the clinic with oral omeprazole and amoxicillin tablets without significant improvement of symptoms. After surgery, the symptoms of abdominal distension and pain improved.
Basic information】Male, 62 years old
Disease Type】Esophageal hiatal hernia, reflux esophagitis, chronic gastritis
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】April 2022
Treatment plan】Surgical treatment (laparoscopic esophageal hiatal hernia repair + fundoplication under general anesthesia) + oxygen absorption + intravenous infusion (cefixime dry suspension, omeprazole acid suppression, glucose rehydration)
Treatment period】Discharge from hospital after 4 days of postoperative observation
Treatment effect】No abdominal distension, abdominal pain, no discomfort after eating, acid reflux and heartburn symptoms improved significantly
I. Initial consultation
The patient, 62 years old, was accompanied by his family to the clinic, complaining of acid reflux and heartburn for more than 3 months, especially after a full meal, when turning over and bending over. The patient took oral omeprazole and amoxicillin on his own at home, but the symptoms were not significantly relieved, so he came to our outpatient clinic for further diagnosis and treatment. According to the patient’s medical history, the possibility of gastroesophageal reflux disease and chronic gastritis was considered, and the patient and his family agreed to be hospitalized.
II. Treatment process
After admission, the patient was firstly given relevant tests, such as routine blood, urine, coagulation four, infectious four, biochemical complete set, tumor markers, routine electrocardiogram, chest X-ray, etc. These tests were generally normal, and the H. pylori test HP (-). The patient was given an upper gastrointestinal tract imaging suggestive of esophageal hiatal hernia, chronic gastritis, and inflammation of the duodenal bulb. Gastroscopy suggested reflux esophagitis (grade A) and chronic atrophic gastritis. Combining the history, symptoms and laboratory tests, the diagnosis was esophageal hiatal hernia, reflux esophagitis, and chronic gastritis. The patient was informed that surgery was needed for esophageal hiatal hernia, and after the patient agreed, laparoscopic esophageal hiatal hernia repair + fundoplication was performed under general anesthesia. Postoperatively, the patient was treated symptomatically with water fasting, cardiac and oxygen monitoring, oxygen administration, intravenous cefixime dry suspension for anti-inflammation, omeprazole for acid suppression, and glucose rehydration.
III. Treatment effect
On the 1st postoperative day, the patient’s general condition was good, with no obvious discomfort, no abdominal distension and abdominal pain, no fever and chills, no nausea and vomiting. The abdomen was soft on pressure, without pressure pain and rebound pain, and the bowel sounds were weak. The patient was instructed to fasting water, supplemental sugar saline, and intravenous infusion of omeprazole acid suppression and cefixime dry suspension for anti-inflammation. After giving the patient a liquid diet on the 2nd postoperative day, the patient had no obvious discomfort and continued the intravenous drug infusion. On the 3rd postoperative day, the patient had no discomfort, and the patient’s diet was subsequently adjusted. On the 4th postoperative day, the patient’s symptoms of acid reflux and heartburn improved significantly, and no positive signs were found on physical examination, and he was discharged from the hospital.
IV. Notes
We are glad that the patient’s postoperative condition was effectively controlled and he was discharged successfully.
1. Inform the patient to pay attention to rest, reasonable diet, and improve poor lifestyle habits. including a light diet, balanced meals, do not eat too much or too full, three regular meals, less spicy and stimulating, greasy food, and appropriate exercise to prevent recurrence of the disease.
2. Avoid bending and lifting heavy objects after meals, and avoid wearing tight clothes, etc. It is not advisable to work immediately after meals, and pay more attention to rest. Keep the head high and foot low position when sleeping.
3. Regularly review gastroscopy and abdominal ultrasound in outpatient clinics to watch for acid reflux and heartburn.
V. Personal insight
Esophageal hiatal hernia is one of the common digestive system diseases. Most patients do not need surgical treatment when there are no symptoms, but if symptoms such as acid reflux, heartburn, upper abdominal pain, nausea and vomiting appear, they need timely treatment, either medication or surgery according to the actual situation. This patient was considered to have esophageal hiatus hernia, reflux esophagitis, and chronic gastritis after completing relevant tests, and was promptly treated with surgery, and her symptoms were effectively improved. Therefore, hiatal hernia needs to be treated early, and most patients recover well after treatment.