Gastropericardial fistula as a complication in a refractory gastric ulcer after esophagogastrostomy with gastric pull-up

Abstract

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.

Keywords: Gastropericardial fistula; esophagogastrostomy; refractory gastric ulcer.

Fig. 1

Esophagogastroduodenoscopy revealing a huge, deeply penetrating gastric ulcer on the anterior wall of the upper body.

Fig. 2

Chest CT scan showing a focal lesion bulging out of the posterior gastric wall and protruding into the pericardial space with severe thickening of the adjacent pericardium.

Fig. 3

Esophagogastroduodenoscopy 2 weeks later; an improvement of the previous gastric ulcer to the healing stage is evident.