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Comments by E. C. James, MD, reiterating some points of his excellent article entitled "Postemetic Rupture of Herniated Cardia of the Stomach: A Variant of Boerhaave's Syndrome" are noted and appreciated. His conjectures concerning the case described in my Letter to the Editor are not precisely accurate, but his remarks about Belsey and Nissen procedures are cogent.To set the record straight, the modified Belsey repair of my patient's hiatal hernia was done in August 1972. It was done through a right transthoracic approach at the time of pulmonary surgery, leaving the left hemidiaphragm unscathed. Her singular postemetic rupture into the left pleural cavity of a herniated cardia of her stomach occurred almost three years later, in 1975. After she had vomited all ingested materials for three days in 1975, a stat barium swallow examination disclosed an intact hiatal hernia repair with no esophagogastric abnormalities noted. Her continued
Gallivan GJ. Postemetic Rupture of Herniated Cardia of the Stomach-Reply. JAMA. 1984;251(4):471. doi:10.1001/jama.1984.03340280027020
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