Gastropericardial Fistula as a Complication in a Refractory Gastric Ulcer after Esophagogastrostomy with Gastric Pull-Up

A gastropericardial fistula, defined as penetration of a gastric lesion into the pericardium, is a rare occurrence. Such a fistula is usually associated with a huge ulcer in the gastric fundus, an ulcer within a hiatus hernia, a history of esophagogastric surgery, the concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs), or Zollinger-Ellison syndrome. The patient in this case presented with shoulder pain and melena, caused by a gastropericardial fistula that had occurred as a late complication of postoperative esophagogastrostomy and a refractory gastric ulcer. Despite the severity of the condition, the patient showed great improvement after medical treatment and the fistula was cured at the end.

A Case of Gastropericardial Fistula as a Complication after Esophagectomy with Esophagogastrostomy for Esophageal Cancer / 대한소화기내시경학회지

The gastric pedicle is commonly used for the reconstruction following the resection of esophageal cancer. We recently experienced a case in which gastric ulcer occurred eighteen months postoperatively. A 60 year-old man complaining of chest pain, dry cough, mild fever and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy because of esophageal cancer. Chest X-ray and CT scan showed pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach pedicle and the pericardium. Upper GI endoscopy showed beating heart through the fistulous opening. The patient expired with sepsis on the twenty second days after an emergent operation. Gastropericardial fistula caused by a peptic ulcer perforation after the esophgectomy and esophagogastrostomy operation is a very rare complication and brings a fatal result. Early detection using the chest radiography, electrocardiogram, echocardiography, upper GI study and physical examination, and an immediate treatment are therefore mandatory.