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July 5, 1965

Further Experience With Obstructed Diaphragmatic Hernias

Author Affiliations

From the departments of radiology and surgery, State University of New York at Buffalo, and Buffalo General Hospital.

JAMA. 1965;193(1):71-73. doi:10.1001/jama.1965.03090010077030

IN A PREVIOUS communication, the mechanism of obstruction in para-esophageal hernias was described in detail.1 Observations on four patients were cited to establish the validity of the following theory: When the cardia and body of the stomach are in intrathoracic location, obstruction does not occur. When the cardia descends through the diaphragmatic defect and the fundus remains in intrathoracic location, the diaphragmatic defect has to accomodate the gastric antrum and also the subcardiac portion of the stomach. The crowding of these two lumens necessarily narrows them. Also, peristalsis is initiated below the cardia and cardiac emptying is further complicated by the force of gravity. As fluids, food, and air enter the cardia, the condition is aggravated by dilatation. In the cases presented, it was shown that, occasionally, decompression of the cardia was followed by its ascent into intrathoracic location and the obstruction was relieved. Two recent cases have added