Paraesophageal hernias (PEHs) result from a defect of the diaphragmatic hiatus with a gradual enlargement of the hiatal opening, allowing abdominal contents to shift into the mediastinum. PEHs are often confused with sliding hiatal hernias; however, it is paramount that physicians understand the subtle presentation differences in the types of diaphragmatic incompetence, as treatment may vary greatly. The type IV giant PEH is a dangerous variant that, once recognized, usually requires surgical intervention. In recent years, the laparoscopic approach has been associated with decreases in morbidity, hospital stay, and time off work, as well as increased quality of life. This case involves the proper workup and minimally invasive treatment of a 56-year-old black female who presented with a symptomatic giant PEH with colon, stomach, and duodenum displacement into the chest.
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