Which hiatal hernia involves the fundus protruding through the diaphragm while the gastroesophageal junction remains in place?

• A. Type I sliding
• B. Type III mixed
• C. Type IV large hiatal hernia
• D. Type II paraesophageal

Answer: (D)

In this scenario, the key idea is where the gastroesophageal junction sits relative to the diaphragm. In a paraesophageal hernia, the gastroesophageal junction remains in its normal position below the diaphragm, while part of the stomach (usually the fundus) herniates through the hiatus into the chest. This is distinct from sliding hernias, where the junction itself moves above the diaphragm, and from mixed or larger hernias that involve additional parts of the stomach or other organs. So the description of the fundus protruding through the diaphragm while the gastroesophageal junction stays put fits paraesophageal hernia perfectly.