Gastropericardial fistula: getting to the heart of the matter

Abstract

BackgroundGastropericardial fistula is a rare life-threatening condition, being reported only 65 times in modern literature.Case presentationA 67 year-old man who presented with weight loss, chest pain and epigastric pain was found to have pericardial effusion and pneumopericardium on computed imaging. Endoscopy and histology confirmed a gastric adenocarcinoma within a hiatus hernia, which had fistulated to the pericardium. His condition was complicated by pulmonary emboli and lobar infarction, all contributing to rapid deterioration and death.ConclusionReview of all previously published cases reveals that factors which predict poorer prognosis are older age, cancer etiology and conservative management. Conversely, protective factors include younger age at presentation, previous gastroesophageal surgery or ulcers as an etiology, and aggressive procedural and surgical management. Although the diagnosis is viewed as largely fatal by many clinicians, operative management has contributed to a statistically significant reduction in mortality from 69 % in the pre-2000 era to 11 % in the post-2000 era. This study summarizes diagnostic methods and treatment interventions and prognostication in this rare condition.

Fistula-Related Pericarditis as a Complication of Gastric Bypass Surgery

“…The first case of pneumopyopericardium caused by subphrenic abscess due to gastric ulceration was described by Hallin in 1863 [1]. Subsequently, in 1947, Harp and colleagues published the first description of a gastric communication between the stomach and the pericardial sac [1]. They described the perforation of a gastric tumor into the pericardial sac.…”

“…They described the perforation of a gastric tumor into the pericardial sac. A total of 66 cases have been described until 2016 [1]. In some cases, the patients presented with these symptoms for months and even years before consulting [1].…”

“…Gastropericardial fistula is a life threatening and abnormal communication between the stomach and the pericardial sac [1].…”

“…The most common presentation is a complication of prior surgery involving the stomach or the esophagus [2]. It usually occurs within a hiatal hernia and rarely occurs transdiaphragmatically [1]. Clinical findings, while inconsistent, include left shoulder tenderness due to diaphragmatic or pericardial irritation, pyrosis, epigastric pain, dyspnea and tachycardia [3][4][5][6].…”

Image of the month: Gastropericardial fistula

“…Its etiology includes previous gastrointestinal surgery, perforating gastric ulcer and perforating cancer. [1][2] In this case the perforation was due to an ulcerated peritoneal metastasis around the antrum and duodenal bulb. Although it is uncommon, gastropericardial fistula should be considered alongside pulmonary embolism and ileus in patients affected by peritoneal metastasis whenever they present with unexplained insidious chest and abdominal pain with hypotension.…”