Answer A1: Para-esophageal (Rolling) hiatus hernia, the chest | International surgical boards

Answer

A1: Para-esophageal (Rolling) hiatus hernia, the chest x ray reveals the shadow of the stomach behind the heart, with disappearance of the gas bubble at its normal site.

A2: CT scan with oral contrast gives more accurate details than barium meal in trendelenburg position, as CT can also reveal the contents of the hernial sac such as small bowel or colon in addition to the stomach.

A3: Operative treatment is nearly always advised, as these herniae are dangerous and liable for strangulation, gangrene and perforation unlike the sliding variety.