Pyopericardium is an acquired disease associated with very high complication rates. Pyopericardium is a very rare form of pneumopericardium. The nontraumatic causes of pneumopericardium include gastro-pericardial fistula that can occur in refractory gastric ulcers, stomach or esophageal neoplasia, and in surgical interventions of the stomach, such as the Niessen fundoplication procedure. The case of life-threatening pneumopericardium associated with gastro-pericardial fistula resulting from the incarceration of a giant hiatal hernia is reported.