Introduction:

Laparoscopic fundoplication has become the surgical treatment of choice for gastroesophageal reflux disease due to minimal complications, one of which is esophageal or gastric perforation, this last one has the lowest incidence, but is the one with the worst prognosis. Most gastric perforations are detected and treated intraoperatively and those detected in the postoperative period require reoperation and present a high morbidity and mortality due in some cases to the presence of acute mediastinitis, of which the reports in the literature are limited. In addition, there are few reported cases of perforation with simultaneous herniation.

Method:

A clinical case of a patient who underwent intrathoracic gastric perforation is presented as the complication of a laparoscopic fundoplication, presenting acute mediastinitis. It describes its management and evolution as well as a review of the subject. This case was managed with surgical reoperation, drainage and placement of pleural and pericardial drains.

Results:

The patient died despite adequate treatment.

Conclusions:

Postoperative gastric perforation by laparoscopic fundoplication may be complicated by acute mediastinitis, the most lethal chest infection. It is a rare complication, with a difficult diagnosis due to its non-specific presentation and its late diagnosis increases its mortality.