{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:40:09Z","timestamp":1756312809243,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,11,15]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>We present a case of an 82-year-old gentleman with an 18-month history of productive cough. Urgent CT scan of the thorax revealed type 1 hiatus hernia (HH). The patient was managed conservatively with lifestyle modifications to help his reflux symptomology. The patient subsequently presented with acute shortness of breath and vomiting. Repeat CT scan reported a giant incarcerated HH (15\u2009cm). Endoscopy revealed an incidental finding of a 3\u2009cm polypoid lesion in the oesophagus at the level of the carina and histology of biopsies reported an invasive adenocarcinoma. During admission, the patient unfortunately had a hospital acquired infection and cardiac complications which prevented surgical intervention. Patients with suspected HH should be investigated thoroughly with imaging studies including chest X-ray, CT or MRI alongside oesophageal manometry and gastroscopy. Endoscopic evaluation is particularly important as these patients are at higher risk of Barrett\u2019s oesophagus and invasive malignancy.<\/jats:p>","DOI":"10.1136\/bcr-2020-235802","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T14:17:02Z","timestamp":1607609822000},"page":"e235802","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Giant hiatus hernia presenting as a chronic cough masking a sinister diagnosis"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7904-1013","authenticated-orcid":false,"given":"Navin","family":"Mukundu Nagesh","sequence":"first","affiliation":[{"name":"General Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dixon","family":"Osilli","sequence":"additional","affiliation":[{"name":"General Surgery, Queen's Hospital, Romford, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Khoo","sequence":"additional","affiliation":[{"name":"General Surgery, Queen's Hospital, Romford, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,10]]},"reference":[{"key":"2025082708592906000_13.12.e235802.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2007.12.007"},{"key":"2025082708592906000_13.12.e235802.2","doi-asserted-by":"crossref","first-page":"267","DOI":"10.5009\/gnl.2011.5.3.267","article-title":"Clinical significance of hiatal hernia","volume":"5","author":"Hyun","year":"2011","journal-title":"Gut Liver"},{"key":"2025082708592906000_13.12.e235802.3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1080\/17474124.2018.1441711","article-title":"Esophageal hiatal hernia: risk, diagnosis and management","volume":"12","author":"Yu","year":"2018","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2025082708592906000_13.12.e235802.4","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e3283426f57"},{"key":"2025082708592906000_13.12.e235802.5","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-008-0754-x"},{"key":"2025082708592906000_13.12.e235802.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g6154"},{"key":"2025082708592906000_13.12.e235802.7","first-page":"42","article-title":"Endoscopic treatments for gastroesophageal reflux disease","volume":"8","author":"Jobe","year":"2012","journal-title":"Gastroenterol Hepatol"},{"key":"2025082708592906000_13.12.e235802.8","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.226450"},{"key":"2025082708592906000_13.12.e235802.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpg.2014.11.002"},{"key":"2025082708592906000_13.12.e235802.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c6280"},{"key":"2025082708592906000_13.12.e235802.11","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1159\/000339211","article-title":"Unusual presentation of a metastatic esophageal carcinoma","volume":"6","author":"Orlicka","year":"2012","journal-title":"Case Rep Gastroenterol"},{"key":"2025082708592906000_13.12.e235802.12","first-page":"620","article-title":"The changing profile of esophageal cancer presentation and its implication for diagnosis","volume":"99","author":"Gibbs","year":"2007","journal-title":"J Natl Med Assoc"},{"key":"2025082708592906000_13.12.e235802.13","doi-asserted-by":"crossref","DOI":"10.3399\/bjgpopen20X101001","article-title":"Patient symptom experience prior to a diagnosis of oesophageal or gastric cancer: a multi-methods study","volume":"4","author":"Humphrys","year":"2020","journal-title":"BJGP Open"},{"key":"2025082708592906000_13.12.e235802.14","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1002\/bjs.1800691217","article-title":"Cough dynamics in oesophageal cancer: prevention of postoperative pulmonary complications","volume":"69","author":"Sugimachi","year":"1982","journal-title":"Br J Surg"},{"key":"2025082708592906000_13.12.e235802.15","doi-asserted-by":"publisher","DOI":"10.4103\/0970-2113.45201"},{"key":"2025082708592906000_13.12.e235802.16","first-page":"29","article-title":"Photodynamic therapy for esophageal cancer","volume":"2","author":"Yano","year":"2014","journal-title":"Ann Transl Med"},{"key":"2025082708592906000_13.12.e235802.17","first-page":"213","article-title":"Endoscopic therapy of Barrett's esophagus and esophageal adenocarcinoma","volume":"19","author":"Tantau","year":"2010","journal-title":"J Gastrointestin Liver Dis"},{"key":"2025082708592906000_13.12.e235802.18","doi-asserted-by":"crossref","first-page":"903","DOI":"10.21037\/jgo.2018.08.15","article-title":"Esophagectomy from then to now","volume":"9","author":"Takahashi","year":"2018","journal-title":"J Gastrointest Oncol"},{"key":"2025082708592906000_13.12.e235802.19","unstructured":"Collaboration NO-GCA . 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