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INTRODUCTION: The pyo-pneumopericardium is a very rare complication of an incarcerated diaphragmatic hernia.Usually, it depends on the existence of a gastropericardial fistula and, in most cases, it is a deadly complication.
CASE REPORT: We present the case of a 65 year old man who was admitted to our emergency service with clini-cal signs of septic shock. With the help of the CT scan a pyo-pneumopericardium and incarcerated diaphragmatichernia was diagnosed. He was subjected to emergency surgical intervention with double approach (thoracic andabdominal), discerning during surgery the existence of a pericardial abscess due to a gastro-pericardial fistula dueto an incarcerated diaphragmatic hernia. The gastric fundus was resected with abolition of the gastro-pericardialfistula, evacuation of the pericardial abscess, performing the splenectomy (in order to have a better surgical access)and adequate treatment of the diaphragmatic hernia. Despite the medical efforts, the patient died on the 10thpostoperative day due to septic complications. To our knowledge this is the first case reported in the literature ofgastro-pericardial fistula complicated with pyo-pneumo-pericardium due to an incarcerated diaphragmatic hernia. In such cases we consider that only by performing a double surgical approach (thoracic and abdominal) we canprovide a proper resolution of the case, also based on the objective situation found during surgery, where thesplenectomy can provide an easier approach to the diaphragmatic hernia.