Congenital Mixed Type III Hiatal Hernia Revealed by Episodes of Cyanosis in a Neonate: A Case Report

Congenital hiatal hernia is a rare condition in neonates, particularly the mixed paraesophageal form (type III). Clinical presentation is often atypical and may be dominated by respiratory symptoms, which can delay diagnosis. We report the case of a 14 day old premature neonate hospitalized for recurrent episodes of cyanosis. Thoracoabdominal computed tomography revealed a congenital mixed type III hiatal hernia with a right basal intrathoracic stomach associated with combined organoaxial and mesenteroaxial rotation, without signs of gastric ischemia. The hernia sac exerted a mass effect with anterior displacement of cardiovascular structures and was complicated by right lower lobe atelectasis and aspiration pneumonia. The presence of blood in the nasogastric aspirate raised suspicion of gastric volvulus and prompted early surgical management. The patient underwent surgical repair with hiatal closure and Nissen fundoplication. Postoperative recovery was favorable, with complete resolution of cyanotic episodes and sustained respiratory stability.