Hiatus hernia in childhood.

The first description of a hiatus hernia was probably that of Bright (1836), who recorded the autopsy of a girl aged 19 years in whom a large portion of the stomach was in the chest and the cardia was at the level of the fourth dorsal vertebra. In the early part of the present century the condition was thought to be rare; Eppinger's (1911) series of 650 diaphragmatic herniae contained only 11 cases of hiatus hernia and in Quenu's (1920) series of 112 cases of diaphragmatic hernia treated surgically there were only two cases of hiatus hernia. With the introduction and development of radiology it was recognized (Akerlund, 1926) that sliding hiatus hernia, in which the cardia and part of the stomach lie a varying distance above the diaphragm, is the most common form of diaphragmatic hernia and occurs frequently. The condition is found chiefly in the infant and in the middle-aged adult and it has generally been assumed that, in both age groups, similar factors are concerned in the aetiology and the mechanism of production of symptoms. There are, however, significant differences in the clinical features, the natural course of the disease and the response to treatment which suggest that, although the complications may be identical, hiatus hernia in the child is pathogenetically quite distinct from the majority of adult cases. There is little doubt that infantile hiatus hernia is either present at, or develops shortly after birth; symptoms usually date from the first few days of life and the condition has been demonstrated radiologically during the first week. It was considered by Findlay and Kelly (1931) that hiatus hernia in the child is a congenital, developmental anomaly in which the oesophagus fails to lengthen synchronously with the caudal migration of the septum transversum so that the diaphragmatic hiatus comes to surround the stomach instead of the oesophagus. Botha (1958) thought that a large proportion of hiatus herniae is due to such a developmental short oesophagus. The rapid elongation of the oesophagus in the normal embryo occurs during the