Fredrick Che, MD, Nojan Toomari, DO, Ninh Nguyen, MD. University of California Irvine Medical Center.
69 year old male with a history of esophageal adenocarcinoma status post laparoscopic and thoracoscopic Ivor Lewis esophagectomy, presented with abdominal pain and symptoms of bowel obstruction. Images performed showed a giant type 4 hiatal hernia with transverse and descending colon, small bowel, and omentum in the thorax. Due to the lack of improvement after non-operative management, the patient underwent extensive laparoscopic lysis of adhesions and repair of type IV hiatal hernia with mesh. Post-operatively he was able to tolerate a PO diet and was later discharged.