A 62 year-old male presented to the chest pain unit with chest pain and nausea, reporting that the symptoms occurred one hour after dinner. His medical history included a foudroyant event of pulmonary embolism with embolectomy in 2012.
Due to clinical deterioration and the history of pulmonary embolism, we decided to perform a contrast computed tomography angiography (CT). We could rule out aortic dissection and pulmonary embolism, However, CT revealed a mixed axial para-oesophageal upside-down stomach (UDS) compressing the left ventricle (Fig. 1).
Computed tomography (a) and gastrointestinal contrast series (b) show a mixed axial and para-oesophageal upside-down stomach (red arrow) compressing the left ventricle, without any incarcerated portions of the stomach
UDS is the rarest type of hiatal hernia and can manifest clinically in a wide variety of symptoms as demonstrated in this case [1]. As causes of chest pain, gastrointestinal disease other than peptic ulcer or reflux-related diseases which might include UDS were reported to be below 1 % [2]. In UDS patients, complications such as incarceration, volvulus development as well as acute gastric bleeding can lead to a life-threatening emergency with prevalence of 30.4 % and can require immediate surgery [3, 4].
References
Hill LD, Tobias JA. Paraesophageal hernia. Arch Surg. 1968;96:735–44.
Verdon F, Herzig L, Burnand B, et al. Chest pain in daily practice: occurrence, causes and management. Swiss Med Wkly. 2008;138:340–7.
Hill LD. Incarcerated paraesophageal hernia. A surgical emergency. Am J Surg. 1973;126:286–91.
Trainor D, Duffy M, Kennedy A, Glover P, Mullan B. Gastric perforation secondary to incarcerated hiatus hernia: an important differential in the diagnosis of central crushing chest pain. Emerg Med J. 2007;24:603–4.
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L. Hobohm, D. Krompiec, R. Michel, Y. Yang, F. Schmidt, C. Düber, T. Münzel and P. Wenzel declare that they have no competing interest.
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Hobohm, L., Krompiec, D., Michel, R. et al. A rare cause of excruciating chest pain mimicking acute coronary syndrome. Neth Heart J 25, 58–59 (2017). https://doi.org/10.1007/s12471-016-0913-8
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DOI: https://doi.org/10.1007/s12471-016-0913-8