A diagnosis of a hiatal hernia with compression of the heart is made, which is likely the factor contributing to the episodic bradycardia.

Surgery done for hiatal hernia with gastrostomy tube.

Post-op recovery and subsequent growth were good.

Discussion

Congenital hiatus hernia (CHH) is rare in NB period and is due to the herniation of the abdominal organs, most commonly the stomach, into the thorax from a physiologic opening caused by the laxity of the attachment of the stomach and gastro-esophageal junction.

It is different from Congenital Diaphragmatic Hernia which is due to a pathological defect in the diaphragm.

Hiatal hernias have been classified into 4 types:

Type 1- sliding hernia, the most common type, accounting for more than 90% of cases.

Type 2- rolling or paraesophageal hernia

Type 3- a combination of these two types and

Type 4- characterized by the presence of a structure other than the stomach, such as the omentum, colon, or small bowel within the hernia sac

The most common of these is a sliding-type hernia accounting for more than 90% of all the cases of hiatal hernia. Although a paraesophageal hernia is a rare entity it is more prone to incarceration, strangulation, complete gastric herniation with organoaxial volvulus (upside down stomach), and a perforation of herniated viscera.

Symptoms of CHH

respiratory distress
vomiting
poor feeding
failure to thrive,
poor feeding,
Other signs such as bradycardia

Diagnosis of CHH is usually made with a barium swallow esophagography, upper endoscopy, or CT scan showing the herniation of intra-abdominal contents into the thorax.

Chest radiographs may show opacity in the posterior mediastinum with or without an air-fluid level.

Barium swallow will show three or more gastric folds above the diaphragm hiatus and a pouch of stomach more than two cm above the hiatus. On CT scan, the diaphragmatic crura are seen separated by more than 15mm and the protrusion of hernia above the diaphragm hiatus.

Differential Diagnosis would include:

Sepsis
Gastroesophageal Chest radiographs may show opacity in the posterior mediasti-num with or without an air-fluid level. Barium swallow will show three or more gastric folds above the diaphragm hiatus and a pouch of stomach more than two cm above the hiatus. On CT scan, the diaphragmatic crura are seen separated by more than 15mm and the protrusion of her-nia above the diaphragm hiatusreflux disease
Respiratory: pneumonia, pneumatocele, pneumothorax, pleural effusion, and
Congenital diaphragmatic hernia

References

See Prenatal diagnosis of hiatus hernia in a fetus with asplenia syndrome

Prenatal diagnosis of congenital hiatus hernia

	Created by Sridhar Kaushik over 5 years ago

PLAB Medicine Note on Vomiting and Bradycardia in a newborn- case study from NeoReviews April 2019, created by Sridhar Kaushik on 09/04/2019.