Pneumopyopericardium Secondary to Perforation of Benign Gastric Ulcer

Romhilt, Donald W.

doi:10.1001/jama.1965.03080020068028

Cited by 37 publications

(9 citation statements)

References 6 publications

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“…The first survivor of this particular lesion was reported by Dons et al (1964), describing the progress of a 6-year-old girl. Romhilt and Alexander (1965) described a woman with a benign gastric ulcer leading to pneumopericardium, occurring three years after a lower oesophageal resection for benign stricture. Their patient died during the postoperative period.…”

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confidence: 99%

Spontaneous pneumopericardium.

Gossage¹,

Robertson²,

Stephenson³

1976

Thorax

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. (1976). Thorax, 31,[460][461][462][463][464][465]. Spontaneous pneumopericardium. Spontaneous pneumopericardium is a relatively rare event, although cases have been recorded over the past 130 years. Many were associated with malignancy, trauma, infection or as a complication of recent surgery. Attempts at surgical resolution have been infrequent and survival extremely rare. We describe a patient in whom pneumopericardium developed spontaneously and insidiously, probably being present for some weeks before hospital investigation. Surgical exploration revealed the cause to be a benign gastric ulcer without an hiatus hernia or other diaphragmatic defect. Repair was attempted but the patient died in the early postoperative period. From an extensive review of the literature it is clear that spontaneous perforation of a gastric ulcer into the pericardium must be less rare than some authors have suggested.The credit for identification of the first case of pneumopericardium is ascribed by some authors to Bricketeau (1844), who proved his diagnosis post mortem. There had been earlier descriptions but the details are not recorded. Bricketeau also described the loud metallic sound of water being splashed in a closed cavity containing air, the

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confidence: 99%

Spontaneous pneumopericardium.

Gossage¹,

Robertson²,

Stephenson³

1976

Thorax

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“…Nine similar cases were described subsequently [2]. The first description of a direct communication between the stomach and the pericardial sac was by Harp and colleagues in 1947 [3], in which they described the perforation of a gastric tumor into the pericardium.…”

Section: Literature Search and Discussionmentioning

confidence: 99%

Gastropericardial fistula: getting to the heart of the matter

Azzu

2016

BMC Gastroenterol

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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.

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“…Traumatic origins include both internally (blunt) and externally derived penetrating chest wounds, and such trauma is one of the most common causes in man (Shackelford 1931;Westaby 1977;Demetriades et al 1990;Capizzi et al 1995;Gould and Schurr 2001;Roth and Schmid 2002). Fistulas that develop between the pericardium and an adjacent air-filled structure occur in people secondarily to diseases involving the pleura (Rosenbaum et al 1964;Patel and Anand 1966), bronchi (Meyer 1948;Rosenbaum et al 1964;Toledo et al 1972;Owens et al 1990;Serrano-Gonzalez et al 1992;van Ede et al 1994), oesophagus (Stephenson et al 1958;Boser et al 1970) and stomach (Maurer and Mendez 1960;Romhilt and Alexander 1965;Beaugie et al 1966). Gastro-oesophageal or colonic surgeries leading to fistula formation or air introduction during tissue dissection or anastomotic leaks can also result in pneumopericardium, as well as pneumomediastinum, pneumorrhachis and subcutaneous emphysema (Stephenson et al 1958;Romhilt and Alexander 1965;Holton et al 2002).…”

Section: Discussionmentioning

confidence: 99%