John R. Gaughen, Jr., M.D.

April 11, 2005

Discussion

Gastropericardial fistula is a rare entity, most often arising from a perforated benign ulcer, or as a post-surgical or post-traumatic sequela. Case reports of malignant etiologies have also been reported. Clinical presentation is variable, ranging from heartburn to sudden death. Complications include pericarditis and cardiac tamponade. Gastropericardial fistula is a surgical emergency, with delayed treatment carrying a mortality rate of greater than 50%. As in this case, a multimodality approach is often needed to make the diagnosis, including plain films, fluoroscopy, and CT. In this case, the patient was taken emergently to the operating room and found to have a gastropericardial fistula caused by a perforated ulcer at the site of the previous gastric bypass. Pathologic analysis of the resected stomach wall demonstrated chronic inflammatory changes. Post-surgical ulceration is a well documented complication following gastric surgery, with most reported cases associated with fundoplication and bypass procedures. The etiology is unclear.

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