Chronic Constipation Caused by Giant Hiatal Hernia in an Elderly Patient

Hiatal hernia is a medical condition in which the upper part of the stomach or other intra-abdominal organs are displaced into the thorax through an opening in the diaphragm. This case report presents the diagnosis and treatment process of a case who presented with the complaint of chronic constipation and was diagnosed with a giant hiatal hernia. A 72-year-old female patient was admitted to our outpatient clinic in March 2021 with complaints of regurgitation, retrosternal pain and chronic constipation that had lasted for about three years. Nausea and vomiting have also been added to symptoms in the last few months. Physical examination was unremarkable except for tenderness in the epigastric region. Laboratory tests showed only mild leukopenia (3.5*103/mm3) and a high c-reactive protein level (21 mg/dL). Because of chronic constipation, screening endoscopy and colonoscopy were planned for the patient. Endoscopy revealed distal esophagitis and a giant hiatal hernia; colonoscopy revealed diverticula in the sigmoid colon. On computed tomography, a Type IV giant hiatal hernia, including stomach and intestinal loops, was present in the large diaphragmatic defect. Floppy Nissen fundoplication was performed. She was discharged on the 3rd postoperative day without complications.