CONGENITAL PARA-ESOPHAGEAL HIATAL-HERNIA IN INFANCY

Congenital para-oesophageal hiatal hernia (PEHH) is a rare problem in infancy, however, it con stitutes a clinical entity that mandates surg ical repair once the diagnosis is made. In the paediatric age group, a cquired PEHH has been described as a major complication in a number of patients who were treated surgically for gastro-oesophageal reflux (G ER) by Nissen fundoplication. PEHH is a frequently encountered conditi on in elderly patients; it accounts for 5% of diaphragmatic hiatal her nias. In both paediatric and adult patients PEHH, whether congenital o r acquired in origin, is usually associated with potentially lethal co mplications such as gastric volvulus, incarceration, and perforation. In clinical practice true PEHH is extremely rare. The term has been ex panded to include large gastric hiatal hernias where most of the stoma ch and the gastro-oesophageal junction are in the chest. Six infants w ith congenital PEHH are presented, together with an attempt to underst and its possible aetiology and a re view of its current surgical manag ement.