A hiatal hernia arises when part of the stomache protrudes through a hole in the abdominal wall. Any hernia can be serious, but a strangulated hernia can quickly become an emergency, because the protruding part is twisted and dangerously positioned. Strangulated hiatal hernias are usually accompanied by a lot of pain, discomfort and complications.
Hernias are painful, but strangulated hiatal hernias are excruciating. Chest pain is often associated with a strangulated hiatal hernia because the stomach has protruded through a hole in the muscle wall and the blood supply to this protruding tissue has been cut off, causing swelling and excited nerves, which can register even the slightest touch as painful.
Hiatal hernias in general can cause acid to back up into the oesophagus. With strangulated hiatal hernias, the acid reflux can be more severe and have worse complications, such as aspiration of stomach acids.
Strangulated hiatal hernias prevent food from properly entering the stomach and may leave a painful "backed up" feeling in the oesophagus. Difficulty swallowing, also called dysphagia, can lead to stress on the body as patients try to eat less, or limit their diet. The hernia could also lead to a complete blockage of the oesophagus and even liquids cannot enter the stomach.
The area of the hernia may be red and swollen in the early stages but can quickly progress to unhealthy-looking colours, such as an ashy grey, blue or black. This could be a sign of gangrene, also known as necrotic tissue, and indicates that the trapped (strangulated) tissue has gone too long without blood and has died. This is a life-threatening development that must be treated with surgery immediately.
Although not quite as dangerous as the more typical hernia, in which part of the intestine is protruding through the abdominal wall, hiatal hernias need to be monitored. The vast majority of strangulated hernias are treated with surgery to repair the hole and remove any infected or dead tissue. In hiatal cases in which the strangulation was caught early and the stomach has been pushed back through the hernia, a support garment may be worn while the patient schedules surgery for a later date. In all cases, pre- and post-surgery, the patient is advised to refrain from strenuous activity and to rest often so as to not cause another strangulation or to tear the wound.