Background:

the hiatal hernia is the most frequent abnormality of the upper digestive tract, which are classified into four types, these hernias can be by sliding and paraesophageal, the latter being much less frequent presentation in clinical practice as is the case presented type IV; most of them are asymptomatic and are discovered incidentally on chest x-rays or multi-slice CT and when they are symptomatic they are often associated with complications.

Objective:

to describe a patient with hiatal hernia type IV diagnosed by multi-slice CT.

Case report:

a 58-year-old male patient with a history of arterial hypertension, who reported having a diaphragmatic hernia diagnosed 15 years ago, who presents with abdominal pain with a moderate intensity of colic accompanied by abdominal distension, belching, vomiting, and dyspnea. At physical examination, globular abdomen that follows the respiratory movements, painful to superficial and deep palpation. Hydro-aerial noises are heard in the right side of the thorax. Multi-slice CT shows herniation of the stomach, transverse colon and omentum in the right chest cavity through the esophageal hiatus.

Conclusions:

hiatal hernias are the most frequent anomalies of the upper digestive tract but type IV giants with herniation of other abdominal structures, such as colon, omentum, small intestine, liver and pancreas are an infrequent form of presentation of them. Multi-slice CT and barium study of the esophagus, stomach and duodenum are fundamental for the diagnosis and characterization of these lesions.

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