Intrathoracic perforation of stomach ulcer in a massive hiatal hernia

: A case of intrathoracic perforation of a chronic gastric ulcer in a hiatus hernia is presented. A 67-year-old woman had suffered from interscapular pain and epigastric discomfort following large meals for four years. During the week before admission, the epigastric and interscapular pain increased, reaching a crescendo in the 24 hours before the patient's arrival in the emergency room. Chest and abdominal x-ray showed free gas and a large hiatus hernia with an intrathoracic stomach. At laparotomy, the stomach was gently returned to the abdominal cavity, and a perforated chronic gastric ulcer was found on the greater curvature. The ulcer was excised, and the diaphragmatic crura were approximated. Apart from wound dehiscence, the postoperative course was uneventful.