TYPE III MIXT HIATAL HERNIA, A RARE VARIANT WITH SEVERE COMPLICATIONS

Type III – mixt hiatal hernia is a rare variant, resulting from combination of both type I and II, with gastroesophgeal junction situated above the diaphragm and the upper part of the stomach herniated in the posterior mediastinum. The patient present typical gastroesophageal reflux symptoms but also retrosternal pain, dysphagia and respiratory symptoms. Up to one third of the patients may also present complications such as bleeding, obstruction, gastric volvulus,strangulation or perforation. We present the case of a type III hiatal hernia with clinical signs of high intestinal obstruction. Upper digestive endoscopy and imagery identified a mixt hiatal herniaincarcerated, complicated with axial gastric volvulus, a diagnosis that was confirmed during the emergency surgery. The objective of the intervention was repositioning of the stomach in the abdominal cavity without resection of the hernia sac, suturing the diaphragmatic defect associated with an antireflux procedure or gastropexy. Laparoscopic surgical cure of the type III hiatal herniapresents all the benefices of the minimally-invasive surgery.