Gastropericardial fistula presenting with cardiac arrest: a case report

Abstract

Introduction Gastropericardial fistulas are rare conditions, with less than 100 reported cases. The diagnosis is associated with significant morbidity, prolonged hospitalization and often has a fatal outcome. Case presentation We describe a unique case of cardiac arrest caused by pneumopericardium and cardiac tamponade as the acute presentation of a gastropericardial fistula, in a patient admitted with an infection of unknown origin. Rapid return of spontaneous circulation occurred, and a computed tomography scan revealed the diagnosis. A benign penetrating ulcer was found on gastroscopy, and surgical management with laparotomy and gastrorrhaphy was performed. The patient had no risk factors for gastric ulceration. However, he had significant comorbidity, which makes survival through a complicated postoperative course to full recovery remarkable. Discussion This case shows that pneumopericardium due to a penetrating benign gastric ulcer can cause cardiac tamponade, and illustrates the value of a multidisciplinary approach to management.

Chest Pain from Pneumopericardium with Gastropericardial Fistula

“…Gastropericardial fistula is a rare condition typically associated with prior gastroesophageal surgery or gastroesophageal cancer [2]. Presentation is highly variable, ranging from benign left shoulder pain to cardiac arrest from tension pneumopericardium [3].…”

“…Pneumopericardium is often first diagnosed by chest X-ray, but the finding is nonspecific in identifying the etiology. Contrast CT imaging is useful for identifying a fistulous tract between the GI tract and the pericardium [3]. Endos-copy allows diagnosis and localization of a fistula by direct visualization and is beneficial in those unidentified by contrast imaging, and it also allows for biopsy of the ulcer to look for malignancy.…”

“…The gastropericardial fistula is associated with significant morbidity and mortality, reaching as high as 69% in one study [2]. The presentation of gastropericardial fistulas varies, with acute dyspnea, chest pain, hemodynamic instability from cardiac tamponade, or even cardiac arrest from tension pneumopericardium [3]. Conditions most commonly associated with gastropericardial fistulas include prior gastroesophageal surgery such as Nissen fundoplication or hernia repair, gastroesophageal cancer [2], and even ulcers associated with gastroesophageal reflux disease, NSAID use, and Zollinger-Ellison syndrome [4][5][6].…”