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Hiatal Hernia with Pancreatic Volvulus

A Rare Cause of Acute Pancreatitis

Patrick Chevallier1, Emmanuel Peten2, Cyril Pellegrino1, Johanna Souci1, Jean Paul Motamedi1 and Bernard Padovani1

1 Department of Radiology, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet II, 151 route de Saint Antoine de Ginestière, BP 3079, 06202 Nice cedex 3, France.
2 Department of Hepatogastroenterology, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet II, BP 3079, 06202, Nice cedex 3, France.



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  		Fig. 1A. —70-year-old man who presented with volvulus of head and tail of pancreas that was herniated through esophageal hiatus, which caused acute pancreatitis. Chest radiograph shows migration of bowel gases (arrows) inside thorax through hiatal hernia.

 


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  		Fig. 1B. —70-year-old man who presented with volvulus of head and tail of pancreas that was herniated through esophageal hiatus, which caused acute pancreatitis. Endoscopic retrograde cholangiopancreatogram shows tapering obstruction in main pancreatic duct between junction of pancreatic head and isthmus (arrow), despite excellent visualization of some secondary branches.

 


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  		Fig. 1C. —70-year-old man who presented with volvulus of head and tail of pancreas that was herniated through esophageal hiatus, which caused acute pancreatitis. Initial axial CT scan shows head of pancreas in its normal anatomic position.

 


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  		Fig. 1D. —70-year-old man who presented with volvulus of head and tail of pancreas that was herniated through esophageal hiatus, which caused acute pancreatitis. Initial axial CT scan shows body—tail portion of pancreas in thorax (curved arrow), volvulated through hiatal hernia. Splenic artery (straight arrow) runs anteriorly along pancreatic portion.

 


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  		Fig. 1E. —70-year-old man who presented with volvulus of head and tail of pancreas that was herniated through esophageal hiatus, which caused acute pancreatitis. Axial CT scan 1 week later shows body—tail portion of pancreas back in its anatomic position, in correlation with regression of biologic abnormalities.

 

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