Pneumopericardium is a rare occurrence. A variety of oesophageal and gastric lesions have been reported to perforate into the pericardium causing pneumopericardium. Although peptic ulceration in hiatus hernia has also been reported to perforate into pericardium, other types of diaphragmatic hernia have not been described as causing perforation into the pericardium. We report a case of a young man who presented with chest pain and was found to have pneumopericardium secondary to a gastropericardial fistula in a recurrent diaphragmatic hernia.

CASE REPORT

A 29 year old man presented in March 2002 to the accident and emergency department with two hour history of severe chest and abdominal pain and dyspnoea. He was in severe pain with a pulse rate of 112/min, blood pressure 169/74 mm Hg, and respiratory rate of 26/min. Resuscitation was begun with oxygen, intravenous fluids, and analgesics. On examination he had decreased air entry at left chest base, tenderness, and guarding in upper abdomen and an upper midline scar. Chest radiography showed pneumopericardium (fig 1). Electrocardiogram showed sinus tachycardia and 1 mm ST segment elevation in V2 and V3. Blood investigations showed a white cell count of 29.1×10⁹/l. Blood gas analysis showed respiratory acidosis with pH of 7.26 and Paco₂ of 7.11 kPa. He was in excruciating pain with persistent tachycardia …