Yonsei Med J.  2010 Mar;51(2):270-272. 10.3349/ymj.2010.51.2.270.

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

• Park S
• Kim JH
• Lee YC
• Chung JB

• KMID: 1126029
• DOI: http://doi.org/10.3349/ymj.2010.51.2.270

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.

Keyword

Gastropericardial fistula; refractory gastric ulcer; esophagogastrostomy

MeSH Terms

Esophagectomy/*methods
Gastric Fistula/*diagnosis/*etiology
Humans
Male
Middle Aged
Pericardium/*pathology
Stomach Ulcer/*complications/*surgery

Figure

• 

  Fig. 1 Esophagogastroduodenoscopy revealing a huge, deeply penetrating gastric ulcer on the anterior wall of the upper body.

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  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.

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  Fig. 3 Esophagogastroduodenoscopy 2 weeks later; an improvement of the previous gastric ulcer to the healing stage is evident.

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