Sliding hiatal hernia with GER
The pictures of x-rays shown here were taken from a young 2 years old male child with severe dilatation of oesophagus and sliding hiatal hernia. He was severely malnourished with a weight of only 13 pounds. Massive reflux can be seen right up to proximal oesophagus. It requires special care to empty the contents of oesophagus and stomach at the time of induction of anesthesia to prevent aspiration pneumonitis. In such patients importance of scrupulous preoperative assessment cannot be overemphasized. Beware of problems of nutritional, metabolic, fluid and electrolyte disturbances.
Professor Naeem Khan, Islamabad (Pakistan)