Perforation of Gastric Ulcer Associated with Paraesophageal Hernia Causing Diffuse Peritonitis

Background/Aims: Free peritoneal perforation of a gastric ulcer associated with paraesophageal hernia causing diffuse peritonitis is an extremely rare event. Methods: Two new cases of this rare condition and the specificities of management are described. Results: One patient recovered well after surgery, while the other died with signs of persisting sepsis and multiple system organ failure. Conclusion: In the wide spectrum of complications related to paraesophageal hernia, free peritoneal perforation of an associated ulcer seems to be one of the gravest. Early elective repair of the paraesophageal hernia is justified.