A Massive Para-Esophageal Hernia: an Unusual Cause of Tension Physiology Leading to Cardiac Arrest

Here, we describe the case of a 28-year-old man with history of super morbid obesity and Type IV para-esophageal hernia, who experienced cardiac arrest following incarceration and strangulation of his hernia sac. He required emergency surgery including an exploratory laparotomy and thoracotomy, with splenectomy, omentectomy, and partial gastrectomy. He was subsequently transferred to our institution due to the anticipated difficulty of restoring intestinal continuity. Continuity was established with a retrocolic Roux-en-Y reconstruction with a 90 cm Roux limb. Despite significant soft-tissue necrosis, he eventually recovered and was able to be transferred back to pursue rehabilitation closer to his home in a rural community.