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May 1964

Strangulated Esophageal Hiatus HerniaUnusual Physical Sign as Accompaniment

Arch Surg. 1964;88(5):750-751. doi:10.1001/archsurg.1964.01310230026007

Strangulation of a hiatus hernia must be rare indeed.1,2 This report documents such a case, and describes a physical sign which led to the correct preoperative diagnosis.

Report of Case  The patient was a white female of 77 years whose illness began with midepigastric pain 18 hours prior to admission. The pain was steady in character and was followed by many bouts of emesis. She had passed no flatus or stool since the onset of pain. She claimed fatty food intolerance, but denied prior dyspepsia or any intestinal disturbance. There was no history of previous abdominal or chest trauma.A cholecystostomy had been performed some 30 years previously, but her gallbladder had never been removed. She was known to have arteriosclerotic heart disease with congestive heart failure and was taking digitalis regularly.The blood pressure was 110/60, pulse 110, temperature 101 F (38.3 C) (rectal), and respirations 18/min. She