Gastro-right ventricular fistula: a deadly complication of a gastric pull-through.

A 70-year-old patient presented with melena, dyspnea, and generalized weakness. An endoscopy revealed a deep ulcer with a pulsatile clot in the intrathoracic gastric tube that had been previously constructed for esophageal replacement. Shortly thereafter, the patient died of exsanguination secondary to a fistula between the stomach and the right ventricle. This complication presents a unique but deadly cause of gastrointestinal bleeding that mandates swift diagnosis and immediate surgical correction.