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 sur
gery, while the other died with signs of persisting sepsis and multiple sys
tem organ failure. Conclusion: In the wide spectrum of complications relate
d to paraesophageal hernia, free peritoneal perforation of an associated ul
cer seems to be one of the gravest. Early elective repair of the paraesopha
geal hernia is justified. Copyright (C) 2000 S. Karger AG, Basel.