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April 1934


Arch Intern Med (Chic). 1934;53(4):594-614. doi:10.1001/archinte.1934.00160100116008

In September, 1931, in a patient who had been under observation for some years, there suddenly developed severe symptoms suggestive of obstruction high up in the gastro-intestinal tract. The patient was admitted to the New England Deaconess Hospital. A roentgenogram showed that two thirds of her stomach was in the thoracic cavity. The diagnosis of hernia of the stomach through the diaphragm, with obstruction at the pylorus, was made. The details will be given in the first case that we report. Treatment was without avail, and the patient died.

Fortunately a postmortem examination was permitted, and several unusual things were found. Two thirds of the stomach was in the thoracic cavity as the roentgenograms had indicated. Of greater importance, however, was the anatomic finding of an esophagus that was foreshortened by at least 4 cm and probably more. The significance of this short esophagus was overlooked at the time, and

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