Hiatal hernias in children: special reference to the short esophagus.

Esophageal hiatal hernias are relatively uncommon in children. Since 1950 we have seen 20 children with hiatal hernias at the Mayo Clinic. During the same period the diagnosis of esophageal hiatal hernia has been made in more than 17,000 adults, and the overwhelming majority of these adults were in the older age group. In this communication we shall review the cases and the roentgenographic findings of some of these 20 children in order to illustrate the types of hernias encountered and the problems that they present. Also, we shall discuss our experience in the management of hiatal hernia and its complications in infants and children. At the time of their first registration, all 20 children were 14 years of age or less. Although most of them were seen early in life, some of them have been followed for as long as 20 years. In all patients, at least part of the stomach was herniated through the esophageal hiatus of the diaphragm into the thorax. By means of the classification of Akerlund,’ the hernias may be classified as paraesophageal hernias, sliding hernias, or hernias of the short esophagus type. In the paraesophageal or rolling hernia, the esophagus is of normal length and extends to the esophageal hiatus but part or all of the stomach is herniated into the thorax through the hiatus. The sliding or gastroesophageal hernia likewise has a portion of stomach within the thorax. However, the esophagogastric junction is located above the esophageal hiatus and the lower portion of the esophagus is usually tortuous and redundant. The term “short esophagus” should be reserved for those patients who have an actual anatomic shortening of the esophagus. In these patients part of the stomach must reside in the thorax in order to provide for esophagogastric continuity.