Large Hiatal hernia followed by Cameron ulcers and sideropenic anemia Case Presentation

Hiatal hernia is accidental asymptomatic finding, but may be associated with gastro- oesophageal reflux disease and Cameron ulcer, in large hiatal hernias.Cameron lesions are linear ulcers or erosions in the folds of the gastric mucosa in diaphragm level from secondary mechanical trauma to diaphragmatic contraction by respiratory excursions in combination with impaired gastric acidity and ischemia. The frequency of Cameron ulcer depends on the size of the hiatal hernia and, increases in proportion to the increase in the size of the hernia. The prevalence rate of hiatal hernia ranges from 0.8 to 5.2% in all patients undergoing upper endoscopy. gastrointestinal. It mainly causes anemia due to iron loss as a result of chronic gastrointestinal bleeding and indigestion. Upper gastrointestinal endoscopy is the gold standard of the diagnostic aspect. Treatment is mainly with antisecretory and iron, for anemia. If it is refractory, surgical intervention is the final treatment. We present the case, a 65-year-old woman with retrosternal postprandial pain, especially in lying down immediately after eating, vomiting, dyspnea, weight loss, fatigue and lethargy. E the patient had a history of long-term symptoms of more than 20 years and treatment with antisecretory. He had a cholecystectomy 10 years ago. The endoscope shows a hernia large hiatal and erosions / ulcerations at the level of gastrodiafragmal contact (ulcers Cameron). Laboratory tests showed low Hgb and Fe (85 g / L or 5.4 mmol / L, respectively). and low MCV (60). After the endoscopic examination, the application was completed. After operative treatment, there was significant clinical and laboratory improvement. For further follow-up, barium radiological examination is envisaged, and after six months, upper digestive endoscopy and cardiopulmonary examination. We conclude that hiatal hernia with Cameron lesion is a rare, potentially destructive but still curable cause of refractory sideropenic anemia. Diagnosis is very difficult in developing countries, where iron deficiency anemia is more common. A high index of suspicion, chest x- ray, barium examination, occult blood test and finally, endoscopic and intraoperative findings are the basis for diagnosis. In the best groupings, upper gastrointestinal endoscopy is a gold standard of diagnostic mode