Large paraesophageal hernia at risk of torsion in an 84-year-old man

We describe the diagnosis of a large paraesophageal hernia that showed a risk of torsion in an 84-year-old man who had good health status and no clinical antecedents of interest until the previous night when he woke up and felt dyspnea, some pain located in the epigastrium and a fever spike. After a short interview with ambiguous and inconclusive answers, the main diagnosis was based on the data obtained from the physical examination, the electrocardiogram, the results of the emergency blood tests, and the hydroaerial level that appeared on the standing chest x-ray; acute myocardial infarction and pulmonary embolism were excluded. Once the patient was stabilized, esophagogastroscopy was requested and some hours later the patient underwent the remaining examinations: intestinal transit, opaque enema and computed tomography scan, which are described in the text. The results of these examinations form the basis of a generic discussion about this case and a literature review from point of view of geriatrics. Few cases of large diaphragmatic hernias in octogenarians have been reported in the literature. We discuss the contribution of the techniques used in the diagnosis of this entity.