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An elderly woman presented in shock with audible stridor, respiratory distress, and a large air filled mass palpable either side of the thyroid cartilage in the anterior triangle of the neck and supraclavicular regions. A large paraoesophageal hernia with massive oesophageal dilatation was confirmed by a chest radiograph (fig 1). Further examination revealed the air filled sack was covering the glottis extending from the posterior pharyngeal wall. Intra-oral manual posterior displacement/compression of the air filled mass revealed grade 1 intubating conditions. A laparoscopic repair of a paraoesophageal hernia and gastric volvulus was performed as an emergency, with further surgery to decompress a massively dilated oesophagus filled with inspissated compacted food stuff.
Respiratory distress has been reported in an adult due to a large paraoesophageal hernia,1 but this case highlights an interesting cause of stridor, previously not reported in the literature, with the appropriate emergency management.
This article has been adapted from Reardon Daniel J, Freschini Angela, Harrison Magnus, Coulson Christopher, Nangalia Lakshman L. Oesophageal dilatation due to a paraoesophageal hernia and gastric volvulus as a cause of stridor Emergency Medicine Journal 2007;24:734
Competing interests: None.