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Figure 12b: Completely disrupted fundoplication with recurrent hernia in a patient with recurrent reflux symptoms. (a) Upright anteroposterior air-contrast esophagram shows that recurrent hiatal hernia (HH) does not reduce in upright position. Fixed transverse folds (arrowheads) in distal esophagus suggest longitudinal scarring from reflux esophagitis. The patient likely has a foreshortened esophagus. (b) Upright anteroposterior air-contrast esophagram during barium ingestion shows barium-filled distal esophagus, recurrent hiatal hernia (HH), and no fundoplication where one should exist (arrows).
