Cardiopulmonary arrest secondary to compression of the heart owing to esophageal hiatal hernia: a case report

Abstract

Background: Esophageal hiatal hernia is commonly encountered in clinical practice. We describe a case of cardiac compression caused by an esophageal hiatal hernia that resulted in circulatory failure and cardiac arrest.

Case presentation: An 82-year-old woman presented to our hospital with vomiting, which progressed to cardiac arrest in the emergency room after computed tomography (CT) imaging. CT revealed gastric herniation into the mediastinum, with marked cardiac compression. Cardiopulmonary resuscitation was performed, and a nasogastric tube was inserted for gastric decompression, which resulted in the return of spontaneous circulation and subsequent hemodynamic stabilization. However, the patient died of aspiration pneumonia 4 days later.

Conclusion: Gastric decompression can lead to rapid improvements in respiration and circulation in patients with an esophageal hiatal hernia. Nonetheless, to prevent complications, such as those observed in our patient, definitive surgical treatment is warranted.

Keywords: Circulatory failure; diaphragmatic hernia; esophageal hiatal hernia; tension gastrothorax; upside‐down stomach.

Fig. 1

Chest radiograph showing (A) excessive gastrointestinal gas in the mediastinum or the left side of the chest cavity. A marked right‐sided displacement of the mediastinal shadow is observed. In addition, a marked right‐sided displacement of the trachea can be seen. (B) The expanded stomach was decompressed by the insertion of a nasogastric (NG) tube, which led to the reversal of the mediastinal displacement.

Fig. 2

Chest and abdominal computed tomography scans (plain films) showing a significantly dilated stomach incarcerated within the mediastinum. A marked displacement of the heart and the left lung can be observed. Craniocaudal inversion of the incarcerated stomach, leading to an “upside‐down stomach,” can also be visualized. IVC, inferior vena cava.

Fig. 3

Chest radiograph on the second day of hospitalization reveals no stomach dilation within the mediastinum or mediastinal displacement; however, extensive infiltrative shadows are seen in both lung fields, suggesting severe pneumonia.