Background:

Paraoesophageal hernia accounts for about 5% of all hiatal hernias and is more common in patients over the age of 50. In this case, it may have been a congenital defect, given the patient’s relatively young age. Iron-deficiency anemia occurs in 45.6% of patients with giant paraoesophageal hernia. The anaemia may have been caused by iron malabsorption or chronic blood loss from small mucosal lesions, which are often too subtle to detect macroscopically.

Aim of the case report:

The aim of this report is to highlight the importance of investigating the causes of anaemia and the need to ensure follow-up care. This reduces the risk of overlooking significant illnesses and risk of developing severe or even life-threatening anaemia.

Case report:

A 32-year-old man presented to his general practitioner because of difficulty walking at work due to fatigue, headaches when breathing deeply, and the sensation of food getting stuck in the throat while eating.
Five years ago, he had been diagnosed with iron-deficiency anaemia and was prescribed iron supplements. However, the patient was not invited to follow-up appointments and did not use supplements.

Conclusions:

New laboratory results revealed that he had severe, potentially life-threatening anaemia (Hb 5.9 g/dL). The patient was hospitalised for a blood transfusion and further evaluation. He was found to have a paraoesophageal hernia (Hiatal hernia IV).