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Carrasco Aguilera B, Del Val Ruiz P, Sanz Álvarez L, Cadenas Fernández F, Martínez-Cachero García M. Gastropericardial fistula: A successfully operated heart code. RADIOLOGIA 2024; 66:278-281. [PMID: 38908888 DOI: 10.1016/j.rxeng.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 06/24/2024]
Abstract
Gastropericardial fistula is a rare, extremely serious and life-threatening condition. Its most common aetiology is secondary to iatrogenic injury following gastric surgery. Clinical manifestations may be non-specific with precordial pain, simulating an acute coronary syndrome, and may be accompanied by electrocardiogram abnormalities. Diagnosis is made by thoracoabdominal computed tomography (CT) with oral and intravenous contrast. Treatment is surgical and consists of repair of the anomalous communication. We present the case of an 81-year-old male patient with gastropericardial fistula who underwent surgery, with the aim of reviewing the diagnosis and the appropriate therapeutic strategy.
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Affiliation(s)
- B Carrasco Aguilera
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - P Del Val Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L Sanz Álvarez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - F Cadenas Fernández
- Servicio de Digestivo, Hospital Universitario Central de Asturias, Oviedo, Spain
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2
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Ibrahim AO, Jaber F, Alghizzawi M, Metzinger M, Asif T. CT-Guided Pericardiocentesis in a Case of Tension Pneumopericardium and Tamponade Secondary to an Enteropericardial Fistula. JACC Case Rep 2023; 18:101909. [PMID: 37545683 PMCID: PMC10401056 DOI: 10.1016/j.jaccas.2023.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 08/08/2023]
Abstract
Tension pneumopericardium is most commonly traumatic. Nontraumatic etiologies are rare, but have been reported with gastropericardial and esophagopericardial fistulas. We present the case of a 54-year-old patient who developed a tension pneumopericardium with tamponade secondary to a perforated marginal ulcer in the proximal jejunum with an enteropericardial fistula. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ali O. Ibrahim
- Address for correspondence: Dr Ali O. Ibrahim, Department of Medicine, UMKC School of Medicine, 2411 Holmes Street, Kansas City, Missouri 64108, USA. @Ali_O_Ibrahim
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Carrasco Aguilera B, del Val Ruiz P, Sanz Álvarez L, Cadenas Fernández F, Martínez-Cachero García M. Fistula gastropericárdica: un código corazón operado con éxito. RADIOLOGIA 2023. [DOI: 10.1016/j.rx.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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4
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Ojha S, Bhojwani R, Srivastava P, Sen G. Delayed gastropericardial fistula following gastric pull-up. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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5
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Zuluaga-Zapata N, Lopera-Valle JS, Suarez-Poveda T. Colopericardial fistula presenting with massive rectal bleeding. J Radiol Case Rep 2020; 13:18-23. [PMID: 32190182 DOI: 10.3941/jrcr.v13i11.3722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Colopericardial fistulae constitute a condition with a very low prevalence and a high morbidity and mortality rate. In this case report, we discuss an 80-year-old male patient who presented to emergency services for massive rectal bleeding and signs of hypovolemic shock. Abdominal arteriography and upper gastrointestinal endoscopy were negative for bleeding. Findings indicative of fistula between the left ventricle and the transverse colon were described in computed tomography angiogram and the diagnosis was confirmed endoscopically. The patient was stabilized and the bleeding was self-limited. Direct communication between the gastrointestinal tract and the pericardium, or even with the heart itself, is a rare disease and constitutes a diagnostic challenge.
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Affiliation(s)
| | | | - Tatiana Suarez-Poveda
- Department of Radiology, San Vicente Fundación University Hospital, Medellin, Colombia
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6
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Lam KJ, Tan EW, Spilias D, Gribbin J. Rare case of a gastro-pericardial fistula after gastric bypass surgery. ANZ J Surg 2019; 90:1514-1517. [PMID: 31840924 DOI: 10.1111/ans.15620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Kenneth J Lam
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Elizabeth W Tan
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Dean Spilias
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia
| | - John Gribbin
- Department of Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Cardiogastric Fistula as a Rare Complication After Gastric Banding and Hiatal Hernia Surgery. Obes Surg 2019; 29:1023-1027. [PMID: 30617915 DOI: 10.1007/s11695-018-03682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zolfagharkhani M, Motlagh A, Oladzade S, Babazadeh A, Ebrahimpour S. Gastropericardial fistula: a case report. JOURNAL OF ACUTE DISEASE 2019. [DOI: 10.4103/2221-6189.263712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Gandalini M, Liebig S, Zwicker F, Schuchmann M, Juchems M. Image of the month: Gastropericardial fistula. Clin Med (Lond) 2018; 18:261-262. [PMID: 29858441 PMCID: PMC6334065 DOI: 10.7861/clinmedicine.18-3-261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Matteo Gandalini
- Department of Radiotherapy, Klinikum Konstanz and Radiology Practice, Konstanz, Germany
| | - Sylke Liebig
- Department of Radiotherapy, Klinikum Konstanz and Radiology Practice, Konstanz, Germany
| | - Felix Zwicker
- Department of Radiotherapy, Klinikum Konstanz and Radiology Practice, Konstanz, Germany
| | | | - Markus Juchems
- Department of Diagnostic and Interventional Radiology, Klinikum Konstanz, Konstanz, Germany
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Martin RA, Reuhland B, Carlson LS, Love M, Maxwell RA, Whittle JS. Gastropericardial Fistula Presenting 27 Years after Bariatric Surgery. Clin Pract Cases Emerg Med 2018; 1:435-436. [PMID: 29849366 PMCID: PMC5965240 DOI: 10.5811/cpcem.2017.6.34372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/03/2017] [Accepted: 06/07/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rebecca A Martin
- The University of Tennessee Health Science Center College of Medicine at Chattanooga, Erlanger Medical Center, Department of Emergency Medicine, Chattanooga, Tennessee
| | - Brian Reuhland
- The University of Tennessee Health Science Center College of Medicine at Chattanooga, Erlanger Medical Center, Department of Emergency Medicine, Chattanooga, Tennessee
| | - Lynn S Carlson
- Erlanger Medical Center, Tennessee Interventional and Imaging Associates, Chattanooga, Tennessee
| | - Michael Love
- The University of Tennessee Health Science Center College of Medicine at Chattanooga, Erlanger Medical Center, UT Erlanger Cardiology, Chattanooga, Tennessee
| | - Robert A Maxwell
- The University of Tennessee Health Science Center College of Medicine at Chattanooga, Erlanger Medical Center, Department of Surgery, Chattanooga, Tennessee
| | - Jessica S Whittle
- The University of Tennessee Health Science Center College of Medicine at Chattanooga, Erlanger Medical Center, Department of Emergency Medicine, Chattanooga, Tennessee
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Hervik K, Vognild I, Bjerke LM, Almdahl SM. Gastropericardial fistula presenting with cardiac arrest: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty057. [PMID: 31020136 PMCID: PMC6177083 DOI: 10.1093/ehjcr/yty057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022]
Abstract
Introduction Gastropericardial fistulas are rare conditions, with less than 100 reported cases. The diagnosis is associated with significant morbidity, prolonged hospitalization and often has a fatal outcome. Case presentation We describe a unique case of cardiac arrest caused by pneumopericardium and cardiac tamponade as the acute presentation of a gastropericardial fistula, in a patient admitted with an infection of unknown origin. Rapid return of spontaneous circulation occurred, and a computed tomography scan revealed the diagnosis. A benign penetrating ulcer was found on gastroscopy, and surgical management with laparotomy and gastrorrhaphy was performed. The patient had no risk factors for gastric ulceration. However, he had significant comorbidity, which makes survival through a complicated postoperative course to full recovery remarkable. Discussion This case shows that pneumopericardium due to a penetrating benign gastric ulcer can cause cardiac tamponade, and illustrates the value of a multidisciplinary approach to management.
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Affiliation(s)
- Kjersti Hervik
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North-Norway Tromsø, Tromsø, Norway
| | - Ingrid Vognild
- Department of Radiology, University Hospital of North-Norway Tromsø, Tromsø, Norway
| | - Lars Martin Bjerke
- Department of Gastrointestinal Surgery, University Hospital of North-Norway Harstad, Harstad, Norway
| | - Sven Martin Almdahl
- Department of Cardiothoracic and Vascular Surgery, University Hospital of North-Norway Tromsø, Tromsø, Norway
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Ghalem A, Berrajaa M, Ahsayan K, Aabdi M, Boutahar I, Skiker I, Housni B, Ismaili N, Ouafi NE. Gastropericardial fistula: A rare etiology of chest pain. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917735073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Gastropericardial fistula is an abnormal communication between the stomach and the pericardium. It is a rare, life-threatening condition that has numerous etiologies. We report the case of a 53-year-old male patient, with a history of wedge resection for gastrointestinal stromal tumor, who presented to the emergency department for epigastric and chest pain along with lethargy leading to the uncommon diagnosis of gastropericardial fistula with pneumopericardium. Through this case, we would like to draw clinicians’ attention to gastropericardial fistula as a differential diagnosis in patients presenting for epigastric and/or chest pain with a history of esophagogastric surgery, emphasizing on the key role of computed tomography in this regard, and underscore the management basics of this unusual condition.
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Affiliation(s)
- Amine Ghalem
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Mehdi Berrajaa
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Kamal Ahsayan
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Mohammed Aabdi
- Department of Anesthesia and Intensive Care, Mohammed VI University Hospital, Oujda, Morocco
| | - Imane Boutahar
- Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Brahim Housni
- Department of Anesthesia and Intensive Care, Mohammed VI University Hospital, Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
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Davidson JP, Connelly TM, Libove E, Tappouni R. Gastropericardial fistula: radiologic findings and literature review. J Surg Res 2016; 203:174-82. [PMID: 27338548 DOI: 10.1016/j.jss.2016.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/09/2016] [Accepted: 03/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gastropericardial fistula, a rare condition characterized by an abnormal communication between the stomach and the pericardium, is an emergency as sequelae such as cardiac tamponade and sepsis may lead to hemodynamic instability and death. We aimed to summarize the surgical and radiologic findings of the reported cases published to date, describe their pertinent surgical history, and present an algorithm for diagnosis. METHODS The Pubmed database was searched using the terms: gastropericardial, pericardiogastric, pneumopericardium, pericardial, and pneumopericardium with the term "fistula" added to each term. The search was limited to January 2000-October 2015 and English language publications. RESULTS Thirty five cases were identified. The most common etiology was prior esophageal and/or gastric surgery (80% of cases; esophagectomy = 26%/gastrointestinal reflux disease associated surgery = 23%/bariatric surgery = 11%/partial gastrectomy = 6%/other = 20%). The average duration between presentation and surgery was 7.3 ± 6.2 years (SD). Radiology typically played a crucial role in diagnosis with computed tomography most commonly demonstrated to be the most appropriate modality to demonstrate the fistula and assist in surgical planning. Contrast studies were frequently helpful to confirm the diagnosis. Chest x-ray findings including pneumopericardium and pericardial thickening were contributory but nonspecific. Esophagoduodenoscopy characterized the fistula in cases where imaging was equivocal and may provide therapeutic options. CONCLUSIONS We present the clinical radiologic findings of the 35 cases of gastropericardial fistula reported. This is the first literature review of gastropericardial fistula to focus on the effectiveness of these various diagnostic modalities and to present an algorithm for diagnosis.
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Affiliation(s)
- James Patrick Davidson
- Department of Diagnostic Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Tara M Connelly
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Eileen Libove
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Rafel Tappouni
- Department of Diagnostic Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.
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Kakarala K, Edriss H, Nugent K. Gastropericardial fistula as a delayed complication of a Nissen fundoplication. Proc (Bayl Univ Med Cent) 2015; 28:478-81. [PMID: 26424947 DOI: 10.1080/08998280.2015.11929314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
A 41-year-old man presented to the emergency department with substernal chest pain and was found to have ST elevations in the inferior leads on his electrocardiogram. An emergent cardiac catheterization did not identify significant coronary narrowing. Computed tomography of the thorax demonstrated a pneumopericardium and a hiatal hernia. The patient had a complicated past surgical history, including a Nissen fundoplication and three additional surgeries for postoperative complications. An esophagram later revealed an ulcer and possible fistula, and the patient underwent gastropericardial fistula resection after the fistula failed to close with fibrin sealant application. Enteropericardial fistulas occur infrequently but have high morbidity and mortality rates. This possibility is much more likely in patients with prior gastroesophageal surgery, including laparoscopic Nissen fundoplication.
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Affiliation(s)
- Kokila Kakarala
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Hawa Edriss
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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Case report: benign gastric ulcer erosion leading to a gastropericardial fistula in a patient with no known risk factors. Clin Imaging 2014; 38:547-549. [DOI: 10.1016/j.clinimag.2014.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 02/03/2014] [Indexed: 11/17/2022]
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