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

Abstract

Gastropericardial fistulae are rare and may cause fatal complications such as acute purulent carditis and cardiac tamponade. The present report describes a case of a gastropericardial fistula caused by a peptic ulcer perforating a retrosternal reconstructed gastric tube 2 years after subtotal esophagectomy for esophageal cancer. Surgical intervention involved left thoracotomy, pericardium fenestration, and drainage of the pericardium and left thoracic cavity. The patient suffered postoperative complications including septic shock, acute respiratory distress syndrome, and cardiac insufficiency; however, he recovered after successful surgical intervention. In this case, the withdrawal of proton pump inhibitors and the patient's sustained drinking habit after esophageal replacement surgery may have caused peptic ulcers in the gastric tube. Early diagnosis and surgical treatment of gastropericardial fistulae are essential to avoid fatal complications.

Subxiphoid pericardial drainage for gastric tube ulcer penetrating the pericardium after esophagectomy: A case report

“…Reconstructed gastric tube ulcers have few subjective symptoms because of the sympathetic nerve transection during creation of the gastric tube [ 5 ]; however, they are often only discovered in severe cases. When a gastric tube ulcer penetrates the pericardium, most patients present with symptoms such as fever, chest pain, respiratory distress, and hematemesis [ [5] , [6] , [7] , [8] ].…”