In reporting any unusual case history it is doubtless wise to be conservative in claiming that such a case is unique. The case report included in this paper is in its morbid anatomic data unlike any of the several similar case reports of acquired gastrothoracic fistula gleaned from the medical literature available at the Army Medical Library (the Library of the Surgeon General).
A total of 25 authentic reported cases of gastric ulcer which subsequently invaded the structures above the diaphragm were found.1 It is interesting to note that 21 of these cases were reported before 1900, the reason probably being that since that date laparotomy immediately on the diagnosis of ruptured peptic ulcer has become a routine surgical procedure. Even before 1900 Fenwick stated that there had been only 1 case of perforation of the diaphragm by a gastric ulcer at the London Hospital during forty years.2
HUDSON PB, GAY LC, NEWMAN HE. PNEUMOTHORAX RESULTING FROM A DISSECTING GASTRIC ULCERREVIEW QF THE LITERATURE AND REPORT OF A CASE. Arch Surg. 1945;50(6):301-303. doi:10.1001/archsurg.1945.01230030312006