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

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.