case_images: PMC8286180_01
case_images: Upright chest X-ray showing large intrathoracic hiatal hernia between the yellow arrows.
case_images: CRIC2021-6697016.001.jpg
case_images: PMC8286180_01_CRIC2021-6697016.001.jpg
case_images: fig1
case_images: An 88-year-old female with a past medical history of gastroesophageal reflux disease, hypertension, and anxiety presented to the emergency department with nausea and abdominal pain after chest X-ray and CT (computed tomography) scan of the abdomen performed at an outside facility showed a large hiatal hernia with possible volvulus or gastric obstruction (Figures 1-3) at an outside facility.
case_images: Transverse chest CT of the abdomen showing large hiatal hernia with concern for gastric volvulus or gastric outlet obstruction. The large hernia is between the yellow arrows. The heart is "H," and the debris in the bowel is "D."
case_images: CRIC2021-6697016.002.jpg
case_images: PMC8286180_01_CRIC2021-6697016.002.jpg
case_images: fig2
case_images: An 88-year-old female with a past medical history of gastroesophageal reflux disease, hypertension, and anxiety presented to the emergency department with nausea and abdominal pain after chest X-ray and CT (computed tomography) scan of the abdomen performed at an outside facility showed a large hiatal hernia with possible volvulus or gastric obstruction (Figures 1-3) at an outside facility.
case_images: Coronal CT of chest and abdomen showing the large hiatal hernia located above the diaphragm with the liver "L" apparent.
case_images: CRIC2021-6697016.003.jpg
case_images: PMC8286180_01_CRIC2021-6697016.003.jpg
case_images: fig3
case_images: An 88-year-old female with a past medical history of gastroesophageal reflux disease, hypertension, and anxiety presented to the emergency department with nausea and abdominal pain after chest X-ray and CT (computed tomography) scan of the abdomen performed at an outside facility showed a large hiatal hernia with possible volvulus or gastric obstruction (Figures 1-3) at an outside facility.
case_images: 12-lead EKG showing complete heart block.
case_images: CRIC2021-6697016.004.jpg
case_images: PMC8286180_01_CRIC2021-6697016.004.jpg
case_images: fig4
case_images: Surgical intervention was planned to correct the anatomical defect, but the day prior to her planned surgery, she ate a large meal and became hypotensive, with her 12-lead ECG showing complete heart block (Figure 4).
case_images: 12-lead EKG obtained after NG tube placement and patient reverting back to normal sinus rhythm.
case_images: CRIC2021-6697016.005.jpg
case_images: PMC8286180_01_CRIC2021-6697016.005.jpg
case_images: fig5
case_images: She had a nasogastric tube inserted for decompression, which converted the complete heart block back to normal sinus rhythm (Figure 5).