Gastropericardial fistula after failure of laparoscopic hiatal repair.

We describe a 77-year-old patient with gastropericardial fistula occurring 5 years after laparoscopic surgery for hiatal hernia and gastroesophageal reflux. The patient presented with isolated intermittent substernal pain without fever. Chest radiographs disclosed extensive pneumopericardium and thoracic computed tomography suggested gastropericardial fistula between the pericardium and the surgical wrap, slipped into the thorax. Emergency surgery allowed successful repair through laparotomy via the trans-hiatal approach.