Have you suddenly observed a bulge on the upper side of your abdomen, particularly one that appears suddenly when lying down or coughing?
It is crucial to take these signs seriously. These symptoms may not represent common lumps and could indicate potentially serious complications that require immediate medical attention.
Understanding the various potential causes of this bulge can help facilitate timely and effective intervention for better health outcomes.
Some possible underlying causes include hiatal hernia, a condition in which the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. This type of hernia can manifest as a visible lump in the upper abdomen, often accompanied by heartburn and discomfort.
What do you know about Hiatal Hernia?
A type of hernia consists of protrusion of the upper part of the stomach through an opening in the diaphragm into the chest or thoracic cavity accompanied by heartburn and visible as a lump in the upper abdomen.
When the part of the stomach can rise into the chest, causing a noticeable bulge in the upper abdomen, this bulge commonly presents as a swelling that enlarges after eating or when in the recumbent position and may be palpated roselike in relation to the ribs, which are painful and require attention.
Beyond a visible bulge, hiatal hernia can cause a range of distressing symptoms, including:
Heartburn (acid reflux)
Vomiting of blood or passing of black stool
Chest pain or upper abdominal pain
Shortness of breath
Trouble swallowing or dysphagia
Feeling full quickly
Anemia (low red blood cell count)
Regurgitation (stomach acid or stomach contents back up into your esophagus)
The 60-60 Rule: A Surprising Statistic
Did you know that by the age of 60, nearly 60% of adults will have some degree of hiatal hernia? Among individuals with morbid obesity, the prevalence is even higher, around 37%. This highlights the significant impact of lifestyle and body weight on the development of this condition.
Types of Hiatal Hernias
Hiatal hernias are classified into two types: sliding hiatal hernia and paraesophageal hiatal hernia.
Sliding Hiatal Hernia
The most frequent type of Hernia accounts for nearly 95% of sliding or axial hernias.
This condition can be symptomless, but the symptoms appear if it is accompanied by gastroesophageal reflux.
It occurs when the junction connecting the esophagus (food pipe) with the stomach via the upper portion of the stomach passes through the diaphragm’s hiatus and enters the chest cavity.
Cause: fat lodgement in the areas covering the hiatus, deterioration of the musculature as a result of aging, pregnancy, and gallstones.
Paraesophageal Hiatal Hernia
This kind, also known as rolling hiatal hernia, is less common, affecting around 5 to 15%, but potentially more risky.
The gastroesophageal junction remains normal in this case, but the part of the stomach pushes up next to the esophagus in the chest cavity.
Diagnostic Evaluations to Confirm Hiatus Hernia
The following are the diagnostic assessments usually used to aid in diagnosing Hiatal hernia.
General advice they may give is that it is better to go see a doctor for the right assessment. The doctor will conduct several tests to determine whether a person has a hernia:
Barium Swallow or X-ray for the upper abdomen: In this procedure, the patient must swallow a barium or Chalky liquid, and whatever is wrong with the stomach or esophagus will show on X-rays.
Physical Examination: For each of the symptoms, the physician shall check on whether the abdomen is swollen or if there is any tenderness.
Upper Endoscopy: This is done by passing a fiber optic tube with light and a camera at the end of it through the mouth to examine the inflamed esophagus and stomach.
CT Scan: This is going to make it possible for the CT scan to take pictures of the chest and abdomen and, therefore, ascertain the size and the site of the hernia.
Complications arise if ignored:
GERD (gastrointestinal reflux disease) where stomach acid flows back to the esophagus, such as heartburn, regurgitation, or discomfort.
Oesophagitis, an inflammation of the esophagus caused by acid exposure, leads to pain, difficulty swallowing, and potential bleeding.
Strangulation is when the stomach moves into the chest and can become trapped (strangulated), cutting off its blood supply.
Ulcer formation and stress on the stomach can lead to the development of ulcers, which can cause pain and bleeding.
Treatment for Hiatus Hernia
Treatment for hiatus hernia depends on the severity of symptoms. In many cases, lifestyle changes and medication can help manage the condition. However, for more severe cases, surgery may be necessary.
Diet & Lifestyle Changes:
Eating small meals.
Avoiding foods that trigger acid reflux includes:
Citrus & Tomatoes
Alcohol
Chocolate
Coffee
Fried or Fatty food
Peppermint.
Don’t eat large meals for 2 to 3 hours before going to bed, as it can worsen acid reflux.
Raising the head of the bed by 6–8 inches can help prevent acid from traveling up into the esophagus while sleeping.
Lose weight if you are overweight.
Is hiatal hernia treatable?
Indeed, it is curable if this sickness is diagnosed on time, or it can lead to a severe condition. This can be done through conventional open surgery to minimally invasive surgery, including 3D laparoscopic. It is wanted to emphasize that Hiatal Hernia treatment is quite traditional, more frequently performed in recent years using minimally invasive 3D laparoscopic Nissen Fundoplication.
Surgical Treatment: 3D Laparoscopic Nissen Fundoplication
If the hiatal hernia exceeds 4 cm, then medication is ineffective; surgery may be required. The most effective treatment for a severe hiatal hernia is Nissen fundoplication. This procedure involves wrapping the upper part of the stomach (360 degrees) around the esophagus to prevent acid reflux.
The 3D visualization allows surgeons to operate with superior depth perception and accuracy, reducing the risk of complications and ensuring optimal patient outcomes. Unlike traditional open surgery, which requires a large incision and a longer recovery period, 3D laparoscopic Nissen fundoplication is performed using small keyhole incisions, resulting in minimal pain, reduced blood loss, and faster healing. Most patients are discharged within 24–48 hours and can return to normal activities within 2–3 weeks.
The benefits of 3D laparoscopic Nissen fundoplication extend beyond just quicker recovery. Patients experience less postoperative pain, a lower risk of infection, and a significant improvement in quality of life. The procedure is particularly beneficial for individuals who suffer from severe acid reflux, frequent regurgitation, difficulty swallowing, or respiratory problems due to their hernia. For those with complications such as esophagitis, ulcers, or stomach strangulation, surgery is not just an option—it is a necessity.
At Chirag Enclave, MASSH Hospital is performing 3D laparoscopic Nissen fundoplication, which is here for the first time in India, an advanced minimally invasive technique with small incisions for the surgery. This 3D technology enhances the precision of the surgery, making it safer and allowing for quicker recovery. Patients typically experience less pain and a faster return to daily normal activities compared to traditional open surgery.
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