A defect in the diaphragmatic hiatus may allow upward herniation of the stomach into the chest. A small "sliding hernia" occurs when an enlarged hiatus allows a small portion of the stomach to "slide" upward, and this compromises the lower gastroesophageal sphincter, predisposing to gastroesophageal reflux disease (GERD). Much more rarely, the entire stomach may herniate upward, as shown here with the chest cavity opened and the heart removed at autopsy, and this is called a paraesophageal hernia. Such a dramatic herniation can compromise the blood supply and lead to gastric infarction. Of course, gastric outflow obstruction is likely with this paraesophageal hernia.