A 76-year-old woman was taken to the emergency room because of chest pain and tarry stool. She stated that she frequently used combined preparation containing acetylsalicylic acid, acetaminophen, and caffeine.
Esophagogastroduodenoscopy was performed because of the suspected diagnosis of upper gastrointestinal bleeding. This revealed paraesophageal hernia and an ulcer with covered perforation in the area of the gastric cardia and fundus. Computerized tomography (CT) of the chest and abdomen yielded the diagnosis of an intrathoracic stomach with perforation into the left pleural cavity (Figure) . In an emergency procedure, the proximal portion of the stomach and the neighboring distal portion of the esophagus were resected, with ensuing gastric reconstruction, esophagogastrostomy, and hiatoplasty. Pleural empyema arose as postoperative complication and was treated with irrigation and partial pleurectomy. A persistent pleural fluid collection was drained under CT guidance. The patient was discharged in stable condition after three weeks in the hospital.
Dr. med. Lars-Arne Schaafs, PD Dr. med. Zarko Grozdanovic, Clinic and University Outpatient Department for Radiology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, lars-arne.schaafs @ charite.de
Conflict of interest statement The authors state that they have no conflict of interest.
Cite this as: 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
Translated from the original German by Ethan Taub, M.D.