title: Terminal ileum gangrene secondary to a type IV paraesophageal hernia.
abstract: 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 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type IV PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in PubMed. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type IV PEH with incarceration of only the terminal ileum.
authors.affiliation: Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan.
authors.forename: Ching Tsai
authors.initials: CT
authors.lastname: Hsu
authors.affiliation: Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan.
authors.forename: Po Jen
authors.initials: PJ
authors.lastname: Hsiao
authors.affiliation: Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan.
authors.forename: Chih Chien
authors.initials: CC
authors.lastname: Chiu
authors.affiliation: Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan.
authors.forename: Jenq Shyong
authors.initials: JS
authors.lastname: Chan
authors.affiliation: Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan.
authors.forename: Yee Fung
authors.initials: YF
authors.lastname: Lin
authors.affiliation: Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan.
authors.forename: Yuan Hung
authors.initials: YH
authors.lastname: Lo
authors.affiliation: Ching Tsai Hsu, Chih Chien Chiu, Yuan Hung Lo, Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32551, Taiwan.
authors.forename: Chia Jen
authors.initials: CJ
authors.lastname: Hsiao
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D005260:Female; D005734:Gangrene; D006551:Hernia, Hiatal / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Gangrene; Hiatal; Ileum; Paraesophageal hernia; Thoracic cavity