Benign peptic ulcers penetrating pericardium and heart: Clinicopathological features and factors favoring survival

West, A. Brian; Nolan, Niamh; O’Briain, D. S.

doi:10.1016/0016-5085(88)90689-0

Cited by 56 publications

(44 citation statements)

References 55 publications

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“…Perforations or fistulas may occur in all mediastinal structures [4,7,8,9,10]. Though esophageal ulcer is considered to cause death only rarely [1], its complications such as esophagopericardial fistula carry a high mortality rate [11].…”

Section: Introductionmentioning

confidence: 99%

“…Higuchi et al showed 66% of esophageal ulcers to be complications of GERD [1]. Other predisposing factors for benign esophageal ulcers include long-standing physical or chemical injury (radiation, foreign body, drugs, corrosive substances), infectious diseases (Candida, Herpes simplex virus, Human immunodeficiency virus), connective tissue diseases, and previously performed esophageal or gastric resection [1,2,3,4]. …”

Section: Introductionmentioning

confidence: 99%

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Esophageal Ulcer as a Cause of Death: A Population-Based Study

Rantanen

Sihvo²,

Räsänen³

et al. 2015

Digestion

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Background: This study aimed at defining the mortality and the nature of fatal complications that arise out of esophageal ulcer for one clearly defined geographical area. Methods: In this national, population-based study, the occurrence of fatal esophageal ulcer or ulcer requiring hospital treatment between January 1987 and December 2000 was assessed by the use of Finland's administrative databases. Medical records provided etiology of fatal ulcer and agonal symptoms. Results: Due to an esophageal ulcer, 2,242 patients received treatment in Finnish hospitals, at an annual frequency of 3.2/100,000. Ulcer with hemorrhage (53.5%), perforation (38.4%), or aspiration pneumonia (2.3%) was the cause of death in 86 patients for an annual mortality of 0.12/100,000. Based on the number of ulcers treated, 3.8% cases ended fatally. Gastroesophageal reflux disease (GERD) seemed to be the etiologic factor for ulcer in 68 (79.0%) patients. The most common agonal symptoms were hematemesis (41.8%), abdominal pain (25.6%), melaena (22.1%), and dyspnea (17.4%). Twenty (23.3%) patients were found dead at home. Conclusion: The rarity of the disease, related disorders, and the diversity of symptoms make the complicated esophageal ulcer a diagnostic challenge. Effective monitored treatment for severe GERD may be an important step to prevent fatal outcome.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esophageal Ulcer as a Cause of Death: A Population-Based Study

Rantanen

Sihvo²,

Räsänen³

et al. 2015

Digestion

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show abstract

“…5,6 As early as 1854, ulcerative perforation of the alimentary tract was identified as a cause of "secondary" pericarditis. 7 A 1988 review of esophagopericardial and gastropericardial fistulas showed that previous gastroesophageal surgery was the most common risk factor.…”

Section: Discussionmentioning

confidence: 99%

“…7 A 1988 review of esophagopericardial and gastropericardial fistulas showed that previous gastroesophageal surgery was the most common risk factor. 5 Pericardial involvement was recognized a mean of seven years after surgery and as early as three months afterward. The clinical presentation ranges from the subacute onset of dyspepsia and an insidious progression of epigastric pain 8 to sudden death without preceding symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Gastropericardial Fistula after Laparoscopic Surgery for Reflux Disease

2002

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APAROSCOPIC approaches are now commonly used to treat gastroesophageal reflux disease. 1,2 Many studies have demonstrated the safety, efficacy, and durability of these minimal-access procedures. 3 However, the learning curve for performing laparoscopic surgery in patients with reflux disease is steep, 4 and intraoperative complications can be life-threatening. 3 Reviews of long-term complications have shown that failed repairs (a "slipped wrap" or paraesophageal or hiatal hernia) can cause substantial morbidity. 3,5 We report a case in which a lifethreatening, gastropericardial fistula was a late complication of a laparoscopic Nissen procedure. CASE REPORTA 70-year-old man who was visiting Boston came to the emergency room in January 1998 with pain in his left shoulder that radiated to his neck. The hematocrit was 16 percent. His medical history included symptomatic gastroesophageal reflux that was refractory to medical therapy and prostate cancer, which had been treated with local radiation therapy two years earlier.In December 1996, the patient had undergone a laparoscopic Nissen fundoplication, with resolution of his reflux symptoms. The surgery was performed with a five-trocar technique. The stomach was easily reduced into the abdomen from the hiatal hernia. The short gastric arteries were divided. The right and left diaphragmatic crura were not closed behind the wrap. A complete fundal wrap of the intraabdominal esophagus was performed around an intraluminal bougie. Two nonabsorbable, nonpledgeted sutures secured the posterior portion of the wrap, the esophagus, and the anterior portion of the wrap. The wrap was not secured to the undersurface of the diaphragm.Several months after the surgery, atrial fibrillation and congestive heart failure developed. The atrial fibrillation converted to sinus rhythm with medical therapy. On Thanksgiving Day, 1997, the patient had sudden, severe abdominal pain, which abated after a drenching sweat. Although he did not have additional episodes of severe pain, he had chronic postprandial pain. He lost 9 kg in weight, had intermittent fevers, with temperatures as high as 39.4°C, and had nocturnal sweats.

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Peptic Ulcer Disease

2003

Morson and Dawson's Gastrointestinal Pathology

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Benign peptic ulcers penetrating pericardium and heart: Clinicopathological features and factors favoring survival

Cited by 56 publications

References 55 publications

Esophageal Ulcer as a Cause of Death: A Population-Based Study

Esophageal Ulcer as a Cause of Death: A Population-Based Study

Gastropericardial Fistula after Laparoscopic Surgery for Reflux Disease

Peptic Ulcer Disease

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