Hiatus Hernia ( Diaphragmatic hernia or sliding hernia)

The oesophagus extends from the mouth or pharynx to the stomach which it reaches by passing through an opening in the muscular diaphragm. This opening is known as the hiatus. The oesophagus joins the stomach below the diaphragm in the abdominal cavity. On occasion the opening in the diaphragm is larger than normal and this may cause upper portion or cardia of the stomach to move cranially and come to lie in the thorax. The connection between the oesophagus and the stomach is now situated above the diaphragm in the thorax, instead of in the abdominal cavity. This type of hernia is known as a sliding or hiatus hernia.

The appearance of the valve or sphincter as seen through the Gastroscope

The Normal Valve or Sphincter

The normal valve or sphincter is usually closed. It can be examined through the gastroscope which is used to examine the oesophagus and stomach. Photos can be taken of the valve.The gastroscope can be manipulated into a position in which retrograde visualisation of the junction between oesophagus can be performed.When viewed from above the valve is usually closed

The gastroscope is passed throughthe valve into the stomach. When viewed from below the valve usually closes fairly tightly around the gastroscope. The appearance of an Hiatus Hernia. With the gastroscope the oesophagus and the portion of the stomach above the opening in the diaphragm can be seen. The valve is open and a portion of the stomach is visible above the diaphragm. The hiatus hernia can also be visualised from the stomach by retroflexion of the gastroscope.

The hiatus hernia as seen through the gastroscope from above. The ulcers in the oesophagus are clearly visible. The junction between the oesophagus and stomach is visualised. The portion of the stomach which has been displaced into the thorax can also be seen.The opening in the diaphragm as seen from below as well as the portion of the stomach which has entered the thorax. The valve is wide and open. The lower end oesophagus is visualised and is recognisable by the pink mucous membrane.