DOI: https://doi.org/10.36347/sasjs.2026.v12i05.027

Pages: 474-477

Hiatal hernia is a common condition that may present with a wide range of clinical manifestations, from typical gastroesophageal reflux symptoms to atypical presentations. Diagnostic evaluation relies on complementary imaging modalities, including upper gastrointestinal endoscopy and computed tomography, which are particularly useful for identifying complications such as gastric volvulus or perforation. Management depends on symptom severity and hernia type, ranging from conservative treatment with lifestyle modifications and proton pump inhibitors to surgical repair in complicated or advanced cases. We report a case of a type IV hiatal hernia presenting primarily with chest pain, initially suggestive of a cardiac etiology. Further investigations allowed for the correct diagnosis, highlighting an uncommon clinical presentation. This case emphasizes the importance of considering hiatal hernia in the differential diagnosis of chest pain after exclusion of cardiac causes. Early recognition and appropriate management are essential to prevent complications and improve patient outcomes.