CT Findings of Obstructed Hiatal Hernia and Correlation with Clinical Outcomes.

RATIONALE AND OBJECTIVES: To evaluate computed tomography (CT) findings of hiatal hernia with obstruction, and their correlation with radiology reports, surgical findings, and clinical outcomes. MATERIALS AND METHODS: We retrospectively reviewed patients with obstructed hiatal hernias per electronic medical records from 2017 to 2024, excluding patients without preoperative chest CT. CT scans were reviewed, recording the presence of ischemic findings (gastric wall hypoenhancement, pneumatosis, or extraluminal gas or fluid), gastric volvulus, and gastric redescent. Findings were correlated with radiology reports, intraoperative results, and mortality. Statistical analysis included χ² and Mann-Whitney U tests, with logistic regression for outcome predictors. RESULTS: A total of 71 patients with obstructed hiatal hernia and preoperative CT were included. Most presented acutely (<7 days, 69%), surgery was performed in 96%, surgical or pathologic evidence of ischemia was present in 15 (21%), and 4 (5.6%) of patients died. Gastric volvulus was present in 64 (90%) of patients, and ischemic findings in 13 (18%). Organoaxial volvulus (OR 5.5, P = .019) and gastric redescent (OR 4.5, P = .011) were significantly associated with acute presentation of obstruction in multivariable analysis. Perigastric fluid or stranding demonstrated an association with gastric ischemia (P = .004). All CT ischemic signs showed association with patient mortality (P < .05). Ischemia-related findings were underreported in clinical reports vs our dedicated review, including hypoenhancement reported in 1/4 (25%) of cases, pneumatosis in 1/3 (33%), and extraluminal gas in 1/3 (33%). CONCLUSION: Gastric redescent and organoaxial volvulus were associated with the acute presentation of obstructed hiatal hernias. CT ischemic signs in obstructed hiatal hernias correlate with gastric ischemia and mortality but were infrequently identified in clinical reports.