Hiatal Hernias in Children: Special Reference to the Short Esophagus

¹ Section of Medicine
² Section of Roentgenol
³ Section of Pediatrics

Hiatal hernias are rare in infants and children, as evidenced by the fact that only 20 patients less than 15 years of age with this condition have been seen at the Mayo Clinic in the last 9 years. By contrast, several thousand adults with hiatal hernias have been seen during the same period. Most of the adults were in the older age group.

Of the 20 hiatal hernias encountered in children, two were of the paraesophageal type, one was a sliding hernia, and the remainder were of the short esophagus type. We suspect that in most instances hiatal hernias have a congenital basis in children, but shortening of the esophagus may or may not be an acquired phenomenon.

Hiatal hernias of the paraesophageal and sliding type should be repaired as soon as a diagnosis can be made. Most of our patients with short esophagus came to us with strictures. Treatment in these cases invariably presents problems and the usual surgical methods of repair for hiatal hernia cannot be adapted in cases of short esophagus.

In most of our patients with short esophagus and stricture, a conservative program consisting of dilations over a previously swallowed thread and medical measures such as routine use of antacids and elevation of the head of the patient's bed has been employed. Satisfactory results have been obtained in two thirds of the patients treated by conservative means.