Type IV Paraesophageal Hernia With Mallory-Weiss Bleeding in an Infant: Endoscopic Hemostasis and Laparoscopic Repair.

Hiatal hernia is rare in healthy infants, and acute gastrointestinal bleeding is an uncommon symptom of it. A 9-month-old boy with an unremarkable medical history presented with persistent vomiting, coffee-ground emesis, and severe anemia. Computed tomography revealed herniation of the stomach and transverse colon into the right thoracic cavity, resulting in a diagnosis of type IV paraesophageal hernia. Due to concomitant viral bronchitis, elective repair was scheduled after the anemia was treated. However, while waiting for surgery, the patient vomited repeatedly and his anemia progressed. Emergency endoscopy was performed, revealing an actively bleeding Mallory-Weiss tear. Hemostasis was achieved with endoscopic coagulation, followed by laparoscopic paraesophageal hernia repair with hiatal closure and Toupet fundoplication. The postoperative course was uneventful, and no recurrence was observed. In infants with persistent vomiting and unexplained anemia, hiatal hernia should be considered and staged endoscopic and laparoscopic treatment may be effective in cases with acute bleeding.