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ACG Case Rep J. 2017 May 10;4:e66. doi: 10.14309/crj.2017.66. eCollection 2017.

Transhiatal Herniation of the Pancreas: A Rare Cause of Acute Pancreatitis.

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Department of Medicine, UCLA Medical Center, Los Angeles, CA.
Division of Digestive Diseases, UCLA Medical Center, Los Angeles, CA.
David Geffen School of Medicine at UCLA, Los Angeles, CA.


Transhiatal herniation of the pancreas is rare. Acute pancreatitis secondary to this phenomenon is particularly unusual. A 102-year-old woman presented with 1 day of severe chest pain, vomiting, dyspnea, and diaphoresis. Serum lipase was elevated, and computed tomography angiogram of the chest and magnetic resonance cholangiopancreatography revealed a hiatal hernia containing the pancreas, with associated findings of pancreatitis. Pancreatitis in this setting may be due to repetitive trauma or ischemia from sliding, intermittent folding of the pancreatic duct, or pancreatic incarceration. Mild cases can be managed supportively, with surgery being reserved for severe cases or for younger patients with low surgical risk.

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