A 76-year-old patient was presented to the rescue center with thoracic pain and tarry stools. The patient stated that she frequently took combination preparation of acetylsalicylic acid, paracetamol and caffeine.
An esophagogastroduodenoscopy was performed with the suspected diagnosis of "upper gastrointestinal bleeding". This revealed paraesophageal hernia and covered, perforated ulcer in the area of the cardia and fundus. Computed tomography (CT) of the chest and abdomen revealed the diagnosis of chest stomach perforated into the left pleural cavity (figure) . In an emergency operation, the proximal stomach and the adjacent distal esophagus were resected, followed by gastric reconstruction, esophagogastrostomy and hiatoplasty. Pleural empyema developed as complication in the postoperative course, which was treated with irrigation and partial pleurectomy. Persistent pleural retention was drained using CT. After almost 3 weeks of inpatient stay, the patient was discharged in stable general condition.
Dr. med. Lars-Arne Schaafs, PD Dr. med. Zarko Grozdanovic, Clinic and University Outpatient Department for Radiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, firstname.lastname@example.org
Conflict of interest: The authors explain that there is no conflict of interest
Citation: Schaafs LA, Grozdanovic Z: A 76-year old woman with chest pain and tarry stool. Dtsch Arztebl Int 2017; 114: 544. DOI: 10.3238 / arztebl.2017.0544
The German version of this article is available online: www.-international.de