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An 82-year-old man was referred to our hospital due to upper thoracoabdominal pain. Chest X-ray showed air around the heart. Computed tomography revealed a fistula between the pericardium and stomach. Upper gastrointestinal endoscopy showed ulcerative lesions in the anterior wall of the stomach in the mediastinum. He was thus diagnosed with a gastroepicardial fistula, caused by perforating ulcer of the protruded stomach. Part of the gastric serosa and hernial sac were stuck together strongly, and the fistula was exposed by separation. After repair of the hiatal hernia, the ulcer was closed with omentum. Two drains were placed in the pericardium through the hiatus and the back of the xiphoid process. The patient was discharged on postoperative day 42 with no severe complications.

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