A 94-year-old female patient with a previously undiagnosed hiatal hernia with intrathoracic stomach presented as an emergency. Computed tomography demonstrated free air in the abdomen and mediastinum, consistent with gastric perforation. Intraoperatively, hypoperfusion of the gastric fundus was observed, along with a mediastinal abscess, indicative of a localized fundal perforation. A laparoscopic wedge resection using stapler was performed.
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