Type IV Hiatal Hernia Involving Majority of the Stomach and Part of the Transverse Colon

Of the four types of hiatal hernias, type IV is the least common. It involves herniation of the stomach and another visceral organ past the hiatus of the diaphragm. Evaluation of the hernia can be through imaging, endoscopy, or manometry. Management of hiatal hernias can either be medical or surgical. Our case involves a 31-year-old male who presented with nausea, vomiting, and decreased oral intake for six days. He underwent robotic assisted Nissen fundoplication six months prior due to intractable gastroesophageal reflux disease and small hiatal hernia. Computed tomography imaging revealed a large hiatal hernia involving most of the stomach and part of the transverse colon. Esophagogastroduodenoscopy was limited due to rotation of the stomach as well as complex hernia. The patient ultimately underwent robotic assisted repair of the hernia with mesh placement and gastropexy.