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Pneumopericardium caused by a perforation of a peptic ulcer in a giant hiatal hernia.

Deborah Repullo Jennen, Eric Lebrun, Jean Lemaitre, Didier Hossey and Alexis Therasse

A 54 year-old woman with a history of giant type I hiatal hernia, severe asthma, and obstructive sleep apnea presented at the emergency room with epigastric pain. Abdominal CT scan showed a giant intrathoracic hiatal hernia and a massive pneumopericardium together with an image compatible with peptic ulcer perforation. Within 2 hours a surgical peptic ulcer repair was performed by thoracotomy in the 8th rib space and covered by a pericardial fat patch.