Gastropericardial fistula after failure of laparoscopic hiatal repair

We describe a 77-year-old patient with gastropericardial fistula occurring 5 years after laparoscopic surgery for hiatal hernia and gastroesophageal r eflux, The patient presented with isolated intermittent substernal pain wit hout fever, Chest radiographs disclosed extensive pneumopericardium and tho racic computed tomography suggested gastropericardial fistula between the p ericardium and the surgical wrap, slipped into the thorax. Emergency surger y allowed successful repair through laparotomy via the trans-hiatal approac h.