Gastropleural fistula is a rare condition, most frequently reported as a result of trauma, peptic ulcer disease or malignancy. We report a case of gastropleural fistula in a patient with metastatic ovarian cancer who presented with hydropneumothorax and mediastinal shift. She was successfully managed with an open partial gastrectomy, repair of diaphragmatic defect, and thoracoscopic washout and decortication. Based on our case and review of the literature, surgical repair of gastropleural fistula should be considered as a palliative procedure even in patients with end-stage cancer.
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