Perforated peptic duodenal ulcer in a paraesophageal hernia--a case report of a rare surgical emergency.
BACKGROUND
Paraesophageal hernias are quite common and sometimes feared due to the risk of incarceration and strangulation of any herniated organ. The hereby reported combination of an incarcerated paraesophageal hernia containing a perforated peptic ulcer is extremely rare.


METHODS
An elderly man with multiple medical conditions was admitted due to severe upper abdominal pain. The patient was found to have a paraesophageal hernia and underwent a laparotomy. In the hernia, a perforated benign peptic duodenal ulcer was found. The duodenal defect was over-sewn, the hernial defect was closed and the former hernial cavity was drained by a right-sided chest tube. The patient was discharged one month after surgery and was found to do well at follow-up one month after discharge.


CONCLUSIONS
This is the first report of a patient surviving the extremely rare and life-threatening combination of a perforated peptic duodenal ulcer in a paraesophageal hernia.
Ekelund
Mikael
M
Department of Surgery, Lund University Hospital, SE-221 85 Lund, Sweden. mikael.ekelund@skane.se
Ribbe
Else
E
Willner
Julian
J
Zilling
Thomas
T
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D004322:Drainage; D004381:Duodenal Ulcer / Q000150:complications* / Q000601:surgery; D004630:Emergencies; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000150:complications* / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D008297:Male; D010439:Peptic Ulcer Perforation / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome