Esophagopericardial Fistula with Pyopneumopericardium Secondary to Esophageal Carcinoma

Cheng, Yi-Tso; Chong, Kok Chin; Tsai, Ming-Jen

doi:10.2169/internalmedicine.50.6140

Cited by 5 publications

(6 citation statements)

References 1 publication

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“…The treatment of pneumopericardium is also dependent on its presentation. Patients with hemodynamic instability require emergent pericardiocentesis 1,2,5,7 . Watchful waiting may be considered if asymptomatic and hemodynamically stable, as it happened to our patient and with Caselli et al 3 and Durães‐Campos et al, 6 as it can resolve spontaneously or by treatment of the underlying condition 8 …”

Section: Discussionmentioning

confidence: 76%

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The “airgap” and “swirling bubbles” signs in a patient with esophageal carcinoma

et al. 2023

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Introduction:Pneumopericardium is a dreaded complication in esophageal carcinoma. Case description:We report a case of a 62 year old patient with past history of esophageal cancer with pneumopericardium, without hemodynamic compromise.Admission echocardiogram that revealed a pneumopericadium with the presence of the "swirling bubbles" and the "air gap" sign. A small esophagopericardial fistula was postulated as the cause of the pneumopericardium. He underwent esophageal stent placement with almost complete resolution of the pneumopericardium.Discussion: Pneumopericardium is usually a sign of marked clinical deterioration in neoplasia and leads to patients' death few weeks. Here we presented a case, in which a more fortunate and unusual outcome happened. Case description:We present a case of a 62 year old patient, with a past history of esophageal cancer with pulmonary metastases undergoing palliative chemotherapy treatment and with two palliative esophageal stents. Other past medical history included active hepatitis B, arterial hypertension and dyslipidaemia. He was an ex smoker of 80 pack-year units.

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Section: Discussionmentioning

confidence: 76%

“…Comparing with current literature, 1–6 cases of pneumopericardium have variable prognosis. In the setting of an esophago‐pericardial fistula, it may resolve with therapy directed to the condition responsible for the fistula formation and scarring by second intention, but it is still a dreaded situation.…”

Section: Discussionmentioning

confidence: 89%

The “airgap” and “swirling bubbles” signs in a patient with esophageal carcinoma

et al. 2023

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“…The treatment of pneumopericardium is also dependent on its presentation. Patients with hemodynamic instability require emergent pericardiocentesis [1,2,5,7]. Watchful waiting may be considered if asymptomatic and hemodynamically stable, as it happened to our patient and with Caselli et al [3] and Durães-Campos et al [6], as it can resolve spontaneously or by treatment of the underlying condition [8].…”

Section: Discussionmentioning

confidence: 81%

“…Comparing with current literature [1][2][3][4][5][6], cases of pneumopericardium have variable prognosis. In the setting of an esophago-pericardial fistula, it may resolve with therapy directed to the condition responsible for the fistula formation and scarring by second intention, but it is still a dreaded situation.…”

Section: Discussionmentioning

confidence: 87%

The “Airgap” and “Swirling Bubbles” signs in a Patient with Esophageal Carcinoma

Pinto

Martins

Carvalho

et al. 2022

Preprint

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“…Esophageal surgeons need to be aware of the late complications and associated atypical symptoms of historical procedures which are no longer in common usage. Where an enteropericardial fistula is present, defunctioning of the upper GI tract or repair with transposition of vascularized tissue gives a better chance of a successful outcome.

Summary of treatment strategies for enteropericardial fistulae Types of surgical management Patient outcome Number of patients defunctioned Number of patients with surgical management (interposition including redo fundoplication) Number of patients with nondefunctioning or noninterposition surgery Number of patients with nonsurgical management Number of patients who died during initial resuscitation or surgery (excluding those treated conservatively initially) Resection and transposition of healthy viscusAlive[7] 1,2,5–9 Dead[2] 10,11 (including one substernal bypass)Gastropericardial fistula associated with hiatal hernia ± fundoplicationAlive[9] 12–20 [3] 21,22 (including one alive but with unresolved fistula)Dead[1] 23 [2] 24,25 [2] 3,26 (including one with late surgery)[1] 26 Post surgery for esophageal stricture or atresiaAlive[5] 27–29 (including current case 1 & 2)[1] 30 [1] 31 Dead[3] 32–34 [4] 26,35,36 [1] 37 Post surgery for upper GI malignancyAlive[1] 38 [2] 39,40 [1] 41 Dead[3] 42–44 [4] 45–48 (including one stent)[1] 49 (Autopsy)Upper GI malignancy – nonsurgicalAlive[2] 4,50 (including one stent)Dead[1] 51 [6] 52–57 (including two stents)Miscellaneous (trauma, peptic ulcer)Alive[1] 58 [3] 59,6...

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mentioning

confidence: 99%

Is the way to a man's heart through his stomach? Enteropericardial fistula: case series and literature review

Hamid

Booth

McManus

2012

Diseases of the Esophagus

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Fistula formation between the pericardium and the gastrointestinal tract is rare. Enteropericardial fistulae may present dramatically, many have prodromal symptoms even though they are not symptoms usually associated with esophageal disease. Prompt diagnosis and expedient surgery can result in survival. We describe three cases of enteropericardial fistulae diagnosed during emergency surgery for sepsis or hemorrhage. All had previous surgery though the details were not available to the operating surgeons because of the time that had passed since their original operation. All three patients survived, albeit with prolonged hospital stay and repeated surgery. A review of the English language literature revealed 95 cases (Table 1). Fifty-eight had a history of previous surgery, particularly fundoplication or esophagectomy. Ten had advanced malignancy and were treated conservatively. All eight patients with fistulae, which were iatrogenic or due to foreign bodies, survived without aggressive surgery. For more extensive pathology, a successful outcome was achieved in 32 of the 36 cases when the upper gastrointestinal (GI) tract was defunctioned because of the presence of major sepsis or because the healthy vascularized tissue was transposed into the area at risk for further fistula formation. Where less aggressive surgery was performed only 12 of 27 patients survived (P < 0.0001). Esophageal surgeons need to be aware of the late complications and associated atypical symptoms of historical procedures which are no longer in common usage. Where an enteropericardial fistula is present, defunctioning of the upper GI tract or repair with transposition of vascularized tissue gives a better chance of a successful outcome. [Table: see text].

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Esophagopericardial Fistula with Pyopneumopericardium Secondary to Esophageal Carcinoma

Cited by 5 publications

References 1 publication

The “airgap” and “swirling bubbles” signs in a patient with esophageal carcinoma

The “airgap” and “swirling bubbles” signs in a patient with esophageal carcinoma

The “Airgap” and “Swirling Bubbles” signs in a Patient with Esophageal Carcinoma

Is the way to a man's heart through his stomach? Enteropericardial fistula: case series and literature review

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