Six elderly patients with large hiatus hernias and chronic incarceration of the stomach in the mediastinum are reported. Symptoms were minimal, and consisted of subxiphoid pressure and fullness arising from gastric stasis rather than reflux esophagitis. Four cases are reported, illustrating significant complications. These included mechanical gastric obstruction with or without strangulation, bleeding from gastritis, aspiration pneumonitis and perforation of a gastric ulcer. Incarceration of the transverse colon was also seen. Since clinical and radiological definition of these patients is possible, early surgical treatment is recommended to relieve chronic disability and avoid major complications.
Bell JW. Chronically Incarcerated Hiatus Hernia. Arch Surg. 1972;104(6):831-835. doi:10.1001/archsurg.1972.04180060079019