Observation of the upside-down stomach esophageal hiatal hernia in a cadaver

In the course of a cadaveric dissection in 2006, an upside-down stomach esophageal hiatal hernia was observed in a 91-year-old Japanese woman with kyphosis who had died of brain infarction. There are 31 clinical reports of upside-down stomach esophageal hiatal hernia, but the vascular system was not analyzed in any of these cases. In this specimen, most of the stomach except the pyloric region passed through the esophageal hiatus (approximately 40 mm in diameter) with the greater omentum and into the hernial sac located dorsal to the heart in the thoracic cavity. The greater omentum was raised on the ventral region in the hernial sac and spread toward the upper abdomen through the esophageal hiatus from the sac, without any adhesion in the abdominal cavity. The tail of the pancreas and the spleen were located near the esophageal hiatus. No abnormality was observed in the heart or lungs. The celiac trunk and its main branches were normal, but the left and right gastric arteries, the short gastric artery and the left gastroepiploic artery passed into the hernial sac through the esophageal hiatus. This specimen was classified as the sliding type of esophageal hiatal hernia. We consider the excessive kyphosis of the vertebral column to likely be associated with the formation of such a highly advanced hernia.