Esophageal obstruction by mediastinal seroma after laparoscopic repair of a giant hiatal hernia: a case report.

BACKGROUND

Hiatal hernia is increasingly prevalent in the Western population. Its incidence increases with age and morbid obesity and is higher in females. Symptomatic hiatal hernias, particularly grade IV, are associated with significant morbidity and severe symptoms, and often necessitate acute surgical intervention.

CASE PRESENTATION: We present a case of a 64-year-old Caucasian female patient with acute symptoms of a giant paraesophageal hernia containing the entire stomach, the proximal duodenum with D2 compression, and the pancreatic head. Laparoscopic hernia reduction with Nissen fundoplication was performed. However, 1 month later, the patient returned with symptoms of complete esophageal obstruction due to food impacted in the distal esophagus compressed by a mediastinal seroma. Conservative management after gastroscopic clearance of the impacted food was successful.

CONCLUSION

Management of grade IV hiatal hernias is challenging, burdened with high complication rates and increased morbidity. Rare complications, such as a seroma obstructing the distal esophagus, lack evidence-based standardized treatment. This case underscores the need for vigilant postoperative management and reviews literature on the management of complex grade IV paraesophageal hernias, including rare postoperative complications.