A patient with a sliding esophageal hiatal hernia with chronic digestive bleeding was operated upon by an abdominal approach, with Nissen's technique of fundoplication. His symptomatology of gastroesophageal reflux disappeared, but the bleeding persisted. A roentgenologic control showed that the plicated upper end of the stomach remained in the thorax. The authors discuss the origin of the persisting hemorrhage, concluding that the ectopic stomach was bleeding by a still obscure pathogenic mechanism. The patient was re-operated upon by a left thoracic approach; thefundoplication was undone and the stomach was replaced in the abdomen, fixing it according to Allison's technique. The bleeding was arrested and the patient was in good conditions two months and a half after.surgery.

Un enfermo portador de una hernia hiatal por deslizamiento con sangrado digestivo crónico, es operado por vía abdominal con la técnica de fundoplicatura de Nissen, desapareciendo su sintomatología de reflujo gastroesofágico, pero persistiendo su sangrado. Un control radiológico comprueba que el sector alto, plegado, del estómago permanece en el tórax. Se discute el origen de la hemorragia persistente, concluyéndose que sangra el estómago ectópico por mecanismo patogénico no aclarado. Se reopera por vía torácica izquierda; se deshace la fundoplicatura y se reintegra el estómago al abdomen, fijándolo según la técnica de Allison. Se detiene el sangrado y el enfermo se encuentra bien a los 2 meses y medio ele operado.