Non-traumatic perforation of gastric ulcer in a hiatal hernia to the pericardium.

A patient with ulcer in a hiatal hernia with perforation to the pericardial sac is reported. The symptoms and signs of non-traumatic perforation from esophagus or stomach to the pericardium or heart are described on the basis of a brief review of the literature. A prominent feature of our patient was long-standing pain in the left shoulder. We suggest that this symptom may be a warning of threatening pericardial perforation.