Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Surgery
Volume 2017, Article ID 8412927, 4 pages
Case Report

Jejunal Diverticular Perforation Causing Small Bowel Obstruction in a Type 4 Hiatal Hernia: A Rare Case Report of a Nonagenarian Patient and Review of Relevant Literature

1Department of Trauma and Acute Care Surgery, Allegheny Health Network, Pittsburgh, PA, USA
2Department of General Surgery, Westchester University Medical Center, Valhalla, NY, USA

Correspondence should be addressed to Saptarshi Biswas; ten.tsacmoc@sawsibihsratpas

Received 14 March 2017; Accepted 14 August 2017; Published 10 October 2017

Academic Editor: Marcus L. Quek

Copyright © 2017 Saptarshi Biswas et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Type IV paraesophageal hernia (PEH) is very rare and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a case of a 90-year-old male patient who presented at our emergency department complaining of epigastric pain that he had experienced over the past few hours and getting progressively worse. On the day after admission, his pain became severe. Chest radiography revealed an intrathoracic intestinal gas bubble; emergency exploratory laparotomy identified a type IV PEH with herniation of only the jejunum with perforated diverticula on mesenteric side through a hiatal defect into mediastinum. There are a few published cases of small bowel herniation into the thoracic cavity in the literature. Our patient represents a rare case of an individual diagnosed with type IV PEH with herniation of jejunum with perforated diverticula.