title: Intrathoracic drainage of a perforated prepyloric gastric ulcer with a type II paraoesophageal hernia.
abstract: BACKGROUND
  With an incidence of less than 5%, type II paraesophageal hernias are one of the less common types of hiatal hernias. We report a case of a perforated prepyloric gastric ulcer which, due to a type II hiatus hernia, drained into the mediastinum.
  
  
  METHODS
  A 61-year old Caucasian man presented with acute abdominal pain. On a conventional x-ray of the chest a large mediastinal air-fluid collection and free intra-abdominal air was seen. Additional computed tomography revealed a large intra-thoracic air-fluid collection with a type II paraesophageal hernia. An emergency upper midline laparotomy was performed and a perforated pre-pyloric gastric ulcer was treated with an omental patch repair. The patient fully recovered after 10 days and continues to do well.
  
  
  CONCLUSIONS
  Type II paraesophageal hernia is an uncommon diagnosis. The main risk is gastric volvulus and possible gastric torsion. Intrathoracic perforation of gastric ulcers due to a type II hiatus hernia is extremely rare and can be a diagnostic and treatment challenge.
authors.affiliation: Department of surgery, Deventer hospital, PO Box 5001, 7416 SE, Deventer, The Netherlands. r.pol@dz.nl.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pol
authors.forename: Hiske W
authors.initials: HW
authors.lastname: Wiersma
authors.forename: Bas Jgl
authors.initials: BJ
authors.lastname: Zonneveld
authors.forename: Marinus Eeftinck
authors.initials: ME
authors.lastname: Schattenkerk