Gastropericardial fistula

Changed by Khalid Alhusseiny, 21 Jun 2021

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Gastropericardial fistula is a rare abnormal communication between the stomach and the pericardial sac. This is a life-threatening condition that can lead to ~~sepsis,~~impaired cardiac ~~tamponade~~function, sepsis and eventually death.

Clinical presentation

Gastropericardial fistula can presents with non specific chest and epigastric pain. The suspicion for such diagnosis should be raised in case of recent history of gastroesophageal surgery.
Patients may also present with septicemia.

Pathology

Different etiologies can predispose to gastropericardial fistula, such as:

Esophageal or gastric surgery.
Esophageal or gastric tumors.
Gastric ulcer.
Trauma e.g upper gastrointestinal endoscopy.
Foreign body.
Corrosive ingestion.

Radiographic features

Plain radiography

Gas within the pericardium surrounding the heart (pneumopericardium).

Fluoroscopy

Contrast media within the stomach either ingested or installed through feeding tube (PEG tube) can be seen leaking outside the stomach and reaching the pericardial sac.

-<p>Gastropericardial fistula is a rare abnormal communication between the stomach and the pericardial sac. This is a life-threatening condition that can lead to sepsis, cardiac tamponade and eventually death.</p><h4>Clinical presentation</h4><ul>
+<p>Gastropericardial fistula is a rare abnormal communication between the <a title="Stomach" href="/articles/stomach">stomach</a> and the <a title="Pericardium" href="/articles/pericardium">pericardial sac</a>. This is a life-threatening condition that can lead to impaired cardiac function, sepsis and eventually death.</p><h4>Clinical presentation</h4><ul>
~~-<li> </li>~~
~~-</ul>~~
+<li>Patients may also present with septicemia.</li>
+</ul><h4>Pathology</h4><p>Different etiologies can predispose to gastropericardial fistula, such as:</p><ul>
+<li>Esophageal or gastric surgery.</li>
+<li>Esophageal or gastric tumors.</li>
+<li>
+<a title="Gastric ulcer" href="/articles/peptic-ulcer-disease">Gastric ulcer</a>.</li>
+<li>Trauma e.g upper gastrointestinal endoscopy.</li>
+<li>Foreign body.</li>
+<li>
+<a title="Corrosive oesophagitis" href="/articles/corrosive-oesophagitis">Corrosive</a> ingestion.</li>
+</ul><h4>Radiographic features</h4><h5>Plain radiography</h5><ul><li>Gas within the pericardium surrounding the heart (<a title="Pneumopericardium" href="/articles/pneumopericardium">pneumopericardium</a>).</li></ul><h5>Fluoroscopy</h5><ul><li>Contrast media within the stomach either ingested or installed through feeding tube (<a title="PEG tube" href="/articles/percutaneous-endoscopic-gastrostomy">PEG tube</a>) can be seen leaking outside the stomach and reaching the pericardial sac.</li></ul>

References changed:

3. Hervik K, Vognild I, Bjerke L, Almdahl S. Gastropericardial Fistula Presenting with Cardiac Arrest: A Case Report. European Heart Journal - Case Reports. 2018;2(2):yty057. <a href="https://doi.org/10.1093/ehjcr/yty057">doi:10.1093/ehjcr/yty057</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31020136">Pubmed</a>
2. Ghalem A, Berrajaa M, Ahsayan K et al. Gastropericardial Fistula: A Rare Etiology of Chest Pain. Hong Kong Journal of Emergency Medicine. 2017;25(2):106-9. <a href="https://doi.org/10.1177/1024907917735073">doi:10.1177/1024907917735073</a>
1. Azzu V. Gastropericardial fistula: getting to the heart of the matter. (2016) BMC gastroenterology. 16 (1): 96. <a href="https://doi.org/10.1186/s12876-016-0510-8">doi:10.1186/s12876-016-0510-8</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27542946">Pubmed</a> <span class="ref_v4"></span>