Abstract
An 81-year-old woman complained of wheezing and dyspnea three days after undergoing upper gastrointestinal endoscopy, which had revealed a gastric ulcer, at a medical clinic. She was referred to a hospital, where she was diagnosed as having esophageal hiatus hernia. Although she was transferred to our center and decompression of the stomach through tube insertion was attempted, it was found to be impossible due to perforation of the gastric ulcer in the esophageal hiatus hernia. In this case, the hernia sac expanded because of leakage of gas and gastric juice, causing cardiac failure. Emergency laparotomy was necessary to reduce the size of the hernia sac. The circulatory dynamics immediately stabilized after decompression of the hernia sac, and the postoperative course was excellent.