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Case Reports
. 2025 Jun 11;17(6):e85750.
doi: 10.7759/cureus.85750. eCollection 2025 Jun.

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

Larissa Silva Coimbra  1 , Matheus de Oliveira Santos  1 , Giovanna Lima Labate  1 , Aline Sardow Pereira  1 , Thiago Henrique Sigoli Pereira  1
Affiliations
Case Reports

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

Larissa Silva Coimbra et al. Cureus. .

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.

Keywords: damage control surgery; gastric perforation; hiatal hernia; strangulation; thoracic drainage.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Control computed tomography, performed four months postoperatively, shows no evidence of recurrence or other abnormalities
Figure 2
Figure 2. Bedside chest X-ray showing pleural effusion (transparent yellow oval)
Figure 3
Figure 3. Appearance of left thoracic drainage showing presence of enteric content
Figure 4
Figure 4. Contrast-enhanced CT images
A) Coronal slice showing herniated stomach (yellow arrow) and pleural effusion (red arrow); B) Axial slice showing herniated stomach (yellow arrow) and pleural effusion (red arrow); C) Axial slice showing pneumoperitoneum (white arrow) and subcutaneous emphysema (black arrow). CT, computed tomography
Figure 5
Figure 5. Image of the surgical specimen - subtotal gastrectomy - showing the stomach with perforation and necrotic portion (yellow ring)
See this image and copyright information in PMC

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