In this type of hernia, cardiac end of the stomach passes through an abnormally wide oesophageal opening in the diaphragm (see Fig. 2.6). Clinical manifestation includes salivation, regurgitation and vomiting. The vomiting may sometimes be associated with mucus and blood due to oesophageal irritation. There may be failure to thrive, anaemia and pneumonia due to aspiration. There may be retrosternal pain and burning sensation due to oesophagitis which may lead to stenosis in chronic cases. Diagnostic evaluation includes barium swallow which shows free reflux. These children are usually nursed in uprightlpropped up position, antacids are used in case of oesophagitis and semi solid feeds are used to prevent reflux. Surgery is indicated in case of stenosis.
The symptoms do not appear until baby is two or three weeks old. The child may present with nonbilious vomiting which later on becomes forceful and projectile, regurgitation,'failure to thrive and constant hunger or excessive hunger and willingness to take feed after vommiting. The von~itus may contain mucus and may be blood streaked. Occassionally there may be greenish stools, gastric haemorrhage or Jaundice, dehydration and electrolyte imbalance. ' - Clinical evaluation includes palpaton of an olive shaped mass in the right upper quadrant of the abdomen, epigastric fullness, and peristaltic waves mov'rig from right to left. Diagnositc evaluation includes ultrasound, and a barium meal showing gross narrowing and elongation of pylorus. The stomach is markedly distended wid1 abnormal retention of barium as barium cannot pass in duodenum.