# Intrathoracic Gastric Perforation Secondary to Strangulated Recurrent Hiatal Hernia: A Case Report of Diagnostic and Therapeutic Challenges

## TL;DR

A rare case of stomach perforation due to a complicated hiatal hernia is reported, highlighting diagnostic and treatment challenges.

## Contribution

This case report adds to the understanding of intrathoracic gastric perforation from a recurrent strangulated hiatal hernia.

## Key findings

- Intrathoracic gastric perforation was diagnosed using contrast-enhanced CT scan.
- Emergency subtotal gastrectomy and subsequent surgical reconstruction were required for treatment.
- The patient showed clinical improvement and was successfully discharged after intensive care.

## Abstract

This report discusses a rare and challenging case of intrathoracic gastric perforation secondary to a recurrent strangulated hiatal hernia. The patient, a 52-year-old female with a prior history of thoracic and laparoscopic surgery for hiatal and diaphragmatic hernia, presented with epigastric and chest pain, which progressively led to hemodynamic shock. Initially, a pulmonary infection with parapneumonic pleural effusion was suspected. However, further imaging, including a contrast-enhanced computed tomography (CT) scan, revealed bilateral pleural effusion and herniation of the stomach with perforation into the thoracic cavity, which required emergency surgical intervention. Subtotal gastrectomy was performed, followed by peritoneostomy. Postoperatively, the patient was admitted to the intensive care unit. A few days later, she underwent peritoneostomy revision and Roux-en-Y gastrojejunostomy reconstruction. After clinical improvement, she was transferred to the general ward and subsequently discharged, with outpatient follow-up.