A cardiogastric fistula after gastric tube interposition. A case report and review of literature

Abstract

A patient is presented with massive hematemesis caused by a fistula between the left cardiac atrium and a gastric tube interposition, which was constructed after esophagectomy for esophageal cancer 3 years earlier.

Benign post-esophagectomy gastrocardiac fistula

“…Various Candida species have been recovered from pericardial fluid and pathology specimens following operative treatment of gastrocardiac fistulae [2,3,6]. Chronic peptic ulceration and Candida superinfection have been described as risk factors for fistula formation [2]. The current patient was likely predisposed to Candida overgrowth by his chronic proton pump inhibitor usage [8].…”

“…C. albicans is commonly isolated from oral secretions and has been recovered as a dominant gastric inhabitant in patients on acid suppression therapy [8]. Various Candida species have been recovered from pericardial fluid and pathology specimens following operative treatment of gastrocardiac fistulae [2,3,6]. Chronic peptic ulceration and Candida superinfection have been described as risk factors for fistula formation [2].…”

“…Such fistulae have been described in the setting of malignancy, chemoradiation therapy, or ischemia [1][2][3][4][5]. We report the unusual presentation and successful treatment of a patient with a benign gastrocardiac fistula in the setting of peptic ulcer disease and gastric Candida overgrowth.…”

Gastropericardial fistula resulting from ulcerative perforation of the reconstructed gastric tube after surgery for esophageal cancer

“…A total of eight cases of gastric tube-pericardial fistulae have been reported so far: four of them occurred after surgery for esophageal cancer [11][12][13][14], three occurred 11-20 years after esophageal replacement surgery for esophageal atresia or corrosive injury in children [15][16][17], and one adult case occurred 8 years after surgery because of esophageal rupture [18]. All nine cases, including the present one, are listed in Table 1.…”

“…However, 2 months later, the ulcer in the gastric tube penetrated into the left atrium, and the patient was treated with an omental patch between the gastric tube and pericardium. Schouten recommended closure of the abnormal communication between the esophagus or gastric tube and the heart by interposition of viable tissue [13]. In case 8, the space between the gastric tube and pericardium was filled with a muscle flap of the rectus abdominis.…”