# Successful Transhiatal Repair of Spontaneous Esophagogastric Junction Perforation Contained Within a Hiatal Hernia Sac: A Case Report

## TL;DR

An 86-year-old woman with a hiatal hernia had a successful transhiatal repair of a spontaneous esophageal perforation that was contained within the hernia sac.

## Contribution

This case report presents a novel approach to managing esophageal perforation by utilizing the hiatal hernia sac for containment and repair.

## Key findings

- The perforation was contained within the hiatal hernia sac, preventing severe complications.
- A transhiatal repair was successfully performed without thoracic or abdominal extension of the perforation.
- The hiatal hernia's lax esophageal adventitia helped distribute pressure and avoid further damage.

## Abstract

An 86‐year‐old woman presented with repeated vomiting and hematemesis. Imaging revealed extensive mediastinal food debris accumulation, diagnosing spontaneous esophageal perforation. CT showed debris predominantly in the anterior‐right mediastinum around the esophagogastric junction, with minimal bilateral pleural effusion. Upper gastrointestinal contrast study demonstrated luminal contrast extravasation without thoracic or abdominal extension. Additional history from family members revealed that the patient had been previously diagnosed with a hiatal hernia by a physician. Given stable conditions, we hypothesized that the perforation was contained within the hernia sac and selected a transhiatal approach. Intraoperatively, an approximately 5‐cm longitudinal tear across the esophagogastric junction was identified and successfully repaired with drainage utilizing the hiatal hernia space. Unlike typical esophageal perforation progressing to severe left‐sided empyema, this case's hiatal hernia created lax esophageal adventitia, distributing pressure into the hernia sac and preventing thoracic or abdominal perforation.