Gastropericardial Fistula as a Complication in a Refractory Gastric Ulcer after Esophagogastrostomy with Gastric Pull-Up

Abstract

A gastropericardial fistula, defined as penetration of a gastric lesion into the pericardium, is a rare occurrence. Such a fistula is usually associated with a huge ulcer in the gastric fundus, an ulcer within a hiatus hernia, a history of esophagogastric surgery, the concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs), or Zollinger-Ellison syndrome. The patient in this case presented with shoulder pain and melena, caused by a gastropericardial fistula that had occurred as a late complication of postoperative esophagogastrostomy and a refractory gastric ulcer. Despite the severity of the condition, the patient showed great improvement after medical treatment and the fistula was cured at the end.

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.…”

Acute tension pneumopericardium due to perforated gastric ulcer without diagnostic radiographic findings 72 h before perforation

“…gastropericardial fistulas [5]. A review of cases of pneumopericardium noted that nearly 80% of gastropericardial fistulas were secondary to prior surgery including fundoplication, esophagectomy, bariatric surgery, or partial gastrectomy [6,7]. A minority of patients with pneumopericardium are the result of gastric peptic ulcer disease in the setting of upside-down stomach or a large hiatal hernia [8,9].…”

Pneumo-pyopericardium Mimicking an Acute Myocardial Infarction. A Rare Complication of an Incarcerated Hiatus Hernia and Gastro-pericardial Fistula

“…In many cases, there is a severe alteration of the haemodynamic status due to the occurrence of cardiac tamponade or hypovolemic shock. 4 As the disease is located at the level of the pericardium, electrocardiogram changes suggestive of acute pericarditis may be recorded, consisting in ST segment elevation in all 12 leads, and PR depression. These ECG changes, associated with chest pain, epigastralgia and syncope, in the present case, imitated an acute ST-elevation myocardial infarction (STEMI).…”