Successful Surgical Management of a Perforated Duodenal Ulcer Within an Incarcerated Paraesophageal Hernia

We present a case report of an incarcerated paraesophageal hernia containing a duodenal perforation managed with surgery. The patient is a 65-year-old female with super morbid obesity (BMI 67) and severe malnutrition (albumin 2.9) found to have a large paraesophageal hernia with free air and fluid in the chest and abdomen. On presentation, the patient was in septic shock, and she was taken emergently to the operating room for exploratory laparotomy. Operative findings included an incarcerated paraesophageal hernia with a 3-cm posterior duodenal perforation. A distal gastrectomy with Billroth-II reconstruction and gastropexy were performed. The patient ultimately recovered well and was discharged home. We report a positive outcome in a rare and dangerous case of an incarcerated paraesophageal hernia associated with duodenal perforation and septic shock.