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June 18, 1982

Postemetic Rupture of Herniated Cardia of the Stomach

JAMA. 1982;247(23):3186-3187. doi:10.1001/jama.1982.03320480014013

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To the Editor.—  Indeed, there is nothing new under the sun nor above the diaphragm. The article by Gapp et al (1982;247:811) indicated that isolated rupture through a herniated gastric cardia owing to forceful emesis had not been identified in their review of the literature.I have treated surgically a similar case in 1975.

Report of a Case.—  A 60-year-old woman had previously undergone a right transthoracic ligation of blebs with pleurodesis and a simultaneous modified Belsey repair of a symptomatic hiatal hernia. Three years later, she was seen for a three-day history of acute left submammary, retrosternal, and subscapular pleuritic chest pains, which were associated with vomiting of all ingested materials. Because of a history of phlebitis, she was treated with intravenous heparin sodium for three days for possible pulmonary emboli. She was subsequently treated with warfarin sodium, tetracycline, and intermittent positive-pressure breathing. A left pleural effusion was treated