Hiatal Hernia in an Elderly Patient Complicated by Upper Gastroesophageal Bleeding, Pulmonary Embolism, and Respiratory Failure: A Case Report

Hiatal hernias occur when abdominal contents protrude into the posterior mediastinum through the esophageal hiatus of the diaphragm. They are classified into four types, with Type I (sliding) being the most prevalent. We report a case of a patient diagnosed with a large Type IV paraesophageal hernia. The patient presented with severe symptoms, including coffee ground vomiting and subsequent pulmonary embolism. Despite initial management, the patient's condition deteriorated, leading to respiratory failure. This case highlights the rare complications associated with paraesophageal hernias, particularly the risks of gastrointestinal bleeding and pulmonary complications. It underscores the importance of early recognition and intervention to prevent severe outcomes, such as respiratory failure. Hiatal hernias, though common, can lead to significant morbidity when complications arise. Clinicians should maintain a high index of suspicion for such complications in patients presenting with atypical symptoms.