Introduction

Anaemia induction with a hiatus hernia is generally an uncommon presentation. The prevalence of both the conditions co-existing is very low (6 to 7%).[1] But, HH might contribute the iron deficiency anaemia due to excessive bleeding from the Cameron lesions and peptic ulcers.[2] In present case, type I HH is present hence completely harmless thus chances of GI bleeding are almost diminished. The condition was brought in light by an upper endoscopy. There is no documented data available for treatment of anemic patients with a hiatus hernia with proton pump inhibitors but the same are found to be effective at some extents.[1] This case report focuses upon depletion of patient’s anemic condition due to the mentioned underlying causes.

Case Report

A 55 year old female was admitted to hospital with complaints of weakness, diarrhea, vomiting, severe anemia and edema with slight dyspnea. After going through past medical history it was found out that patient is a known case of non-pitting edema with severe anemia and also has history of black stool since last 50 days. Patient had lost 2 kg in last 2 months. There is no history of hemorrhoids and constipation. The provisional diagnosis was found to be non-pitting edema with severe anemia. Patient’s Hb on admission was 2.5 mg/dl.On examination BP-130/80 mm Hg. Investigations advised to the patient were Renal Function test, Urine analysis, Ultrasonography and an upper GI tract Gastroscopy (Endoscopy).The upper GI endoscopy showed hiatal hernia and enteral duodenal nodularity whereas the USG report highlighted 1.6 – 1.8 cm myometrium uterine heme fibroid to the posterior wall body.

Table 1 Laboratory Findings
Sr no. Test Observed Value Reference Value
1. Hb 2.5 mg/dl 12-15 mg/dl
2. Renal Function Test
a. Sodium 137 mEq/L 136 – 145 mEq/L
b. Potassium 3.6 mEq/L 3.5- 5.1 mEq/L
c. Chloride 109 mEq/L 98- 107 mEq/L

Based on the clinical findings, patient was diagnosed as a known case of anemia with a Hiatus Hernia. Patient was transfused with 4 units of PCV during their stay (1 unit per day).The patient was treated with Optineuron Inj., Vibact, Normal Saline and Pantoprazole.

The patient was kept under observation after the final diagnosis and PCV administrations and medications were continued. On discharge patient had reduced edema and pallor. Patient was discharged after the consecutive day of PCV administration with medications Neurobion forte Tab and Pan 40 for 14 days

Discussion

In this case, the anemic condition of the patient was deteriorated due to unawareness of the previous physician leading to patient’s hospitalization. Patient’s condition improved after the administration of vitamin B complex (Optineuron) as some studies show effectiveness of vitamin B in breaking / wearing off the fibroid masses.[3] Also due to hematocrit administration the iron deficiency of the patient was quickly improved. Surgical repair of the herniation was not required due to very minor discomfort to the patient. The controlled management of case by hematocrit transfusion, PPI and Vitamin B complex led to healthy recovery of the patient.

Conclusion

This case report is a conclusive evidence that presence of heme fibroid, a type 1 hiatus hernia and duodenal nodules can lead to a complex worsened anemia if the latter two conditions remain undetected.[4] Hence every other person with even a mild GI symptom with Anemia must be re-examined by the attending physician before planning further treatment perspectives in the same.[5][6] These re-examination precaution method can help bringing light on hidden conditions and contribute towards a speedy recovery of patient without any further complications.1, 2, 3, 4, 5, 6

References

  1. Iron Absorption and Blood Loss in Patients with Hiatus Hernia Holt J. M., Mayet F. G. H., Warner G. T., Callender S. T., Gunning A. J.. BMJ.1968;3(5609):22-25.
  2. What are uterine fibroids,” MRI-Guid Fibroids W C U. Focus. Ultrasound Surg.2007;111.
  3. A case of giant hiatal hernia in an elderly patient: When spleen, stomach, duodenum and colon slide into thorax- A rare cause of dyspnea and chest pain Gomes Richmond R. The Gazette of Medical Sciences.2020;1(3):007-012.
  4. Guidelines for the Management of Hiatal Hernia - A SAGES Publication 2020.
  5. Large hiatal hernia in patients with iron deficiency anaemia: a prospective study on prevalence and treatment Panzuto F., Di Giulio E., Capurso G., Baccini F., D'Ambra G., Delle Fave G., Annibale B.. Alimentary Pharmacology and Therapeutics.2004;19(6):663-670.
  6. Cameron Lesions: Unusual Cause of Gastrointestinal Bleeding and Anemia Maganty Kishore, Smith Richard L.. Digestion.2008;77(3-4):214-217.