Iatrogenic Parahiatal Hernia With Gastric Herniation and Necrosis after Robotic Hiatal Hernia Repair

A 24-year-old white female with history of robotic hiatal hernia repair and Nissen fundoplication two years ago for hiatal hernia and gastroesophageal reflux disease presented with less than one day history of abdominal pain, nausea, and vomiting. CT of the abdomen showed a parahiatal diaphragmatic hernia with intact Nissen fundoplication, left pleural effusion, and atelectasis (Fig. 1). Reports of secondary parahiatal hernias exist, most commonly after trauma or historic antireflux procedures that using a "relaxing" or counterincision.2, 3 Common symptoms of parahiatal hernias include abdominal pain, dysphagia, nausea, vomiting, and respiratory distress.