Hiatal hernia as the cause of G-induced abdominal pain

Abstract

Sliding hiatal hernias are common and affect approximately 10% to 80% of the general population. The condition typically presents with reflux-type symptoms and is diagnosed either with imaging or endoscopy. In this case, the hernia presented as G-induced abdominal pain. The patient was an F-18 pilot who experienced worsening epigastric abdominal pain proportionate to the amount of accelerative force experienced. The pain would occur at approximately 3 Gs and increase beyond that. The patient was asymptomatic at rest and denied any dysphagia or reflux symptoms. The only other symptom was the occurrence of a similar pain with diaphragmatic spasm, i.e., "hiccup." The patient underwent multiple imaging modalities and procedures and was eventually found to have a sliding hiatal hernia. He underwent a Nissen fundoplication to repair it. Approximately 3 months postoperatively, the patient was able to withstand significant acceleration without pain. He has no lasting sequelae from the hernia or surgery and continues to fly.