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Type IV para-oesophageal hiatal hernia: it’s a gut feeling
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An 89-year-old woman presented with epigastric pain and nausea of 1 day duration. Examination revealed epigastric tenderness with positive bowel sounds and absent breath sounds at both lung bases. A frontal view of the chest (fig 1A) revealed a very large intrathoracic gastric bubble occupying both lower lung fields (marked by arrows). An air fluid level on the right lateral decubitus film …