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Hiatal hernias are relatively uncommon in infants. While patients with small sliding hiatal hernias may be treated medically with satisfactory results, the patients with large hiatal hernias and with associated esophagitis should be seriously considered for surgical intervention. The major factor affecting the results of surgical treatment is the complication of secondary stenosis and/or shortening of the esophagus requiring resection of a portion of the esophagus. Esophageal roentgenograms and esophagoscopy help in the diagnosis of these patients but the final decision is best made during surgery. A case is presented in which the entire stomach as well as the first and second portion of the duodenum had herniated through the hiatus of the diaphragm. Because the length of the esophagus was in doubt, the patient was prepared for a left thoracoabdominal incision and a possible jejunal interposition procedure. By making only the abdominal portion of the incision initially it was found that the hernia could be reduced and repaired via the abdomen, thereby avoiding the thoracic portion of the incision with its added complications.
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© 1965 Published by Elsevier Inc.