A hiatal hernia occurs when the upper portion of the stomach protrudes through the hiatus, the opening in the diaphragm muscle through which the esophagus passes. While many people have this condition without symptoms, a complication can sometimes lead to a medical emergency. Knowing the difference between chronic, manageable symptoms and acute, life-threatening signs is important. Emergency symptoms indicate a severe complication, such as strangulation or obstruction of the stomach tissue.
Symptoms Requiring Immediate Emergency Care
The most serious complications, such as incarceration or strangulation, demand an immediate trip to the emergency room. Strangulation occurs when the blood supply to the trapped stomach tissue is cut off, leading to tissue death (necrosis) within hours. Obstruction, where the herniated stomach blocks the flow of food or gas, is another acute concern requiring immediate intervention.
A sudden onset of severe, unrelenting pain in the chest or upper abdomen is a primary indicator of a serious complication. This pain is sharp and does not subside with rest or over-the-counter antacids. If this pain is accompanied by a racing heart rate, it may suggest the body is entering shock due to internal distress or hemorrhage.
Forceful, persistent vomiting, especially if the vomit contains blood (hematemesis), is an alarming sign. Internal bleeding can also manifest as black, tarry stools, which signals gastrointestinal bleeding requiring immediate evaluation. The inability to pass gas or have a bowel movement, combined with severe abdominal pain, strongly suggests a bowel obstruction.
A high fever (over 100.4 degrees Fahrenheit) with severe reflux symptoms can signal infection or inflammation of the compromised tissue. Any combination of these acute symptoms means the patient should seek emergency services immediately, as the condition could rapidly worsen without surgical intervention.
Common Symptoms and When to Call a Doctor
Most hiatal hernias cause symptoms related to the backward flow of stomach acid into the esophagus, known as gastroesophageal reflux disease (GERD). These common symptoms are chronic and do not signal an acute medical emergency. They typically require management through medication and lifestyle changes rather than an emergency room visit.
The most frequent complaint is heartburn, a burning sensation in the chest that often worsens after eating or lying down. Other common, non-urgent symptoms include the regurgitation of food or sour liquid and frequent belching. Difficulty swallowing (dysphagia) may also occur, particularly if it develops gradually and is manageable.
These chronic symptoms warrant a scheduled consultation with a healthcare provider. If symptoms persist for more than a few weeks, or if over-the-counter medications no longer provide relief, the patient should make an appointment. The doctor can then perform diagnostic tests to confirm the hernia and create a long-term treatment plan.
Immediate Steps and What to Expect at the Hospital
Once the decision is made to go to the emergency room for severe hiatal hernia symptoms, patients should prepare for medical intervention. It is advised not to eat or drink anything (NPO, or nil per os). This precaution is taken because emergency surgery may be required to resolve strangulation or obstruction, and an empty stomach reduces the risk of aspiration during anesthesia.
Bringing a detailed list of all current medications, dosages, and known allergies will significantly speed up the triage process. Upon arrival, the medical team will stabilize the patient and conduct a focused physical examination. Triage may include blood tests to check for signs of internal bleeding, anemia, or infection.
Initial diagnostic imaging often includes a chest X-ray, which can reveal the stomach protruding into the chest cavity, or a CT scan of the chest and abdomen. The CT scan is especially useful in an emergency setting because it quickly shows if the stomach is twisted, obstructed, or if its blood supply has been compromised. These steps confirm the complication and determine the need for immediate surgical repair.