A type IV paraesophageal hernia containing a volvulized sigmoid colon

A type IV paraesophageal hernia is a rare complication in esophageal hiatus and is an uncommon presentation of hiatal hernia. We report herein a 71-year-old man who presented with abdominal pain, nausea and constipation that was attributed to a sigmoid volvulus. At laparotomy, the sigmoid volvulus was identified as strangulated and involved in a type IV paraesophageal hernia in which the esophageal junction was located in its normal anatomic position. The esophageal hiatus was impressively dilated and there was no evidence suggesting previous mechanical disruption of the esophageal hiatus.