Gastroenterology & GI Surgery

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Complex Case Spotlight

Anemia of “Unknown Origin” Revealed to be Caused by Large Hiatal Hernia

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Assessing the Cause of Anemia, Vomiting, Retching

A 68-year-old male presented with a history of anemia as well as complaints of acid reflux, vomiting, retching, and difficulty keeping food down. Multiple tests completed prior to the patient arriving revealed no obvious reason for the chronic blood loss. The patient was receiving regular iron infusions and blood transfusions to treat the anemia.

Coronal view of CT scan showing large intrathoracic stomach.
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Detection of Large Hiatal Hernia

Upon referral for management of worsening symptoms, gastroenterologist Seth Gross, MD, detected a large hiatal hernia via endoscopy, which was subsequently confirmed on a CT scan.

Axial view of CT scan showing large intrathoracic stomach.
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Cameron Lesions and Iron Deficiency Anemia

Dr. Gross suspected that, in addition to causing the symptoms of acid reflux, vomiting, and retching, Cameron lesions associated with the hiatal hernia were causing iron deficiency anemia. The patient was then referred to surgeon Tanuja Damani, MD, and underwent a minimally invasive robotic paraesophageal hernia repair.

Before paraesophageal hernia repair via minimally invasive robotic surgery.
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Paraesophageal Hernia Repair

Mesh reinforcement of the diaphragm was completed during the repair to reduce the risk of hernia recurrence. In total, the procedure lasted 2.5 hours, and the patient was discharged within 48 hours. Following surgery, the patient’s hemoglobin levels – which reached a low of 5.4 g/dl pre-surgery – returned to normal (>15 g/dl), and his symptoms of acid reflux, vomiting, and retching completely resolved. READ THE FULL ARTICLE

After paraesophageal hernia repair via minimally invasive robotic surgery.
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