Intrathoracic omental herniation through the esophageal hiatus in a young patient

We herein present a case of intrathoracic omental herniation through the esophageal hiatus in a young patient. A 21-year-old obese man was asymptomatic, and his chest X-ray demonstrated a large, sharply defined mass. A computed tomography scan of the thorax indicated a large retrocardial mediastinal mass in which the density indicated the presence of fatty tissue judging from the Hounsfield unit range. A thoracotomy was performed under a diagnosis of either mediastinal lipoma or liposarcoma with an encapsulated fatty mass, measuring 17×12×8 cm in size. The mass, however, proved to be an omental herniation through the esophageal hiatus. It is generally assumed that the major contributing factors leading an individual to develop an omental herniation through the esophageal hiatus include aging and obesity. This is the first report of omental herniation through the esophageal hiatus in a patient still in his twenties.