This hernia is considered a Type II. A Type III paraesophageal hiatal hernia combines elements of a Type I and a Type II paraesophageal hiatal hernia, and a Type IV paraesophageal hiatal hernia is characterized by a large defect in the diaphragmatic hiatus that allows other organs such as the colon, pancreas, spleen, or small intestine to herniate.2 Paraesophageal hiatal hernias usually cause more