Perforation of the Intrathoracic Stomach in Hiatal Hernia

Abstract

An 84-year-old woman with a medical history of type I paraesophageal hernia presented to our emergency room with shortness of breath and hematemesis a few hours after polyethylene glycol lavage for colonoscopy. On upper endoscopy, sliding hernia with perforation of the intrathoracic stomach was observed ; computed tomography revealed pneumomediastinum. An emergency midline laparotomy with additional left thoracotomy was performed and partial gastrectomy, hernia repair, and enterostomy were carried out. The patient recovered 27 days after the operation. Gastric perforation in hiatal hernia is rare but can be life-threatening ; therefore, prompt and accurate diagnosis and treatment are necessary.