A hiatal hernia is when part of the stomach moves upward and bulges through the wall of the esophagus and diaphragm. It is caused because of a weakness in the muscle where the esophagus passes through to the stomach. Although hiatal hernias normally occur in adults, they can occur in children as well. For the majority of those with a hiatal hernia, it is a defect at birth and can go unnoticed and without symptoms. Some hiatal hernias develop because of changes in weight, physical activity, vomiting, coughing or even during bowel movements.
Children with a hiatal hernia may feel like there is something burning in the chest and throat, especially after eating. Because of the strain from the hernia, stomach acid is pushed up into the esophagus causing a burning sensation. Some children with a hiatal hernia suffer from reflux disease. Symptoms of a hiatal hernia include chest pain, bloating and problems swallowing caused by the restriction of the stomach.
If a hernia becomes strangulated as it is pinched or twisted, it can be life-threatening because the stomach loses its blood supply. In the case of large hernias, lesions can develop and begin to bleed in the diaphragm.
If a hiatal hernia is suspected, a doctor will most likely order an endoscopy with a barium swallow in order to easily see the area between the esophagus and the stomach. This procedure is often done under a mild anesthesia to decrease the pain and discomfort. X-rays are also used to help the cause of the problem. These procedures can be performed in an outpatient setting.
The majority of treatment options focus on dietary changes, including restricting foods that are acidic or spicy, as well as food and drinks that are caffeinated. In order to reduce the reflux caused by the hiatal hernia, it is important to elevate the head when laying down and avoid eating before bed. Many physicians will recommend eating smaller meals throughout the day to reduce reflux. A doctor may prescribe antacid medication to reduce the possiblility of damage to the esophagus. If the hiatal hernia is large and could become strangulated or twisted, surgery may be recommended. A hiatal hernia can be fixed through laproscopic surgery. A small incision is made and a laproscope (small camera) is inserted into the area and provides live images for the surgeon. A few other small incisions are made for other surgical instruments to be inserted and are used to pull the stomach down into the abdomen. The surgeon will then repair the weakened muscle wall.
Many children are able to get up and walk around the same day of surgery. However, full recovery can be two to three weeks. It is important to reduce the risk of recurrence in the first few months post-op by not allowing any heavy lifting.