American Board of Surgery Qualifying Exam (ABS QE) Practice Test

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What distinguishes a Type 3 PEH from Type 2?

Only the GEJ is above the diaphragm
Both the GEJ and a portion of stomach are above the diaphragm
Stomach is completely below the diaphragm
Stomach is not involved

The correct answer is: Both the GEJ and a portion of stomach are above the diaphragm

A Type 3 Paraesophageal Hernia (PEH) is characterized by the presence of both the gastroesophageal junction (GEJ) and a portion of the stomach migrating above the diaphragm. This distinguishes it from a Type 2 PEH, where only the GEJ is displaced without any portion of the stomach present above the diaphragm. In Type 3 PEH, the herniation involves not just the junction where the esophagus connects to the stomach but includes a part of the stomach itself, which can complicate the condition and lead to a higher risk of gastric volvulus or obstruction. The clinical implications of this herniation type emphasize the necessity for surgical intervention in many cases, as the presence of the stomach in the thoracic cavity can lead to significant morbidity. In contrast, the other scenarios presented involve either the stomach being entirely below the diaphragm or not participating in the herniation at all, which does not align with the definition of a Type 3 PEH. Therefore, the correct answer describes the unique feature of the Type 3 hernia, highlighting both the GEJ and a portion of the stomach being situated above the diaphragm.