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• W2979154830 abstract "Purpose: A 59-year-old male presented with acute onset of abdominal pain, hematemesis, melena, chest pain and dyspnea. His past medical history was significant for T3 N1 distal esophageal adenocarcinoma for which he had an esophagectomy with gastric pedicle pull-up 15 months ago and received neoadjuvant chemoradiation. Restaging studies 3 months ago showed 2 gastric body ulcers on EGD with benign histopathology while on proton pump inhibitors. He initially presented to his primary care physician with bilateral shoulder pain medicated with NSAIDs and prednisone therapy. On presentation hemoglobin was 7 and ECG revealed new onset atrial fibrillation. Upper endoscopy revealed a large ulcer extending from below the esophago-gastric anastomosis to the duodenum at the lesser curvature of the stomach, covered by clot without evidence of active bleeding or visible vessel. A CT scan of thorax, abdomen and pelvis showed new pericardial thickening and pneumopericardium, with suggestive images of connection between distal stomach and pericardium, along with extensive pulmonary ground glass opacities. There was no extravasation of contrast into pleura or pericardium. Patient underwent exploratory laparotomy that revealed extensive gastric ulceration and full thickness erosion of the conduit wall with communication to pericardium, invasion of right lower lobe and erosion of pulmonary veins. An excision of conduit, jejunostomy, thoracotomy and cervical esophagostomy were performed. There were no malignant cells on histopathology. The patient's course was complicated by empyema and pulmonary embolism on 4 months follow-up. Esophageal cancer patients have prolonged survival after esophagectomy. Late complications of this include anastomotic stricture, conduit ulceration and functional conduit disorders. Perforated ulcers of gastric tubes can penetrate neighbor structures in the posterior mediastinum such as the pericardium, leading to gastropericardial fistula. This is a very rare and highly lethal condition, with a mortality of more than 50%. The clinical presentation includes chest pain with shoulder radiation, epigastric pain, dyspnea and arrhythmias. ECG may show changes consistent with atrial fibrillation or pericarditis. CT scan and endoscopy are helpful to establish the diagnosis. However, excessive air insufflation by the endoscope may trigger a cardiac tamponade. Sudden death can occur due to cardiac tamponade. Prognosis with surgical drainage is better that in conservative therapy or percutaneous drainage. GPF of a gastric ulcer should be part of the differential diagnosis in patients with an esophagectomy that present with chest pain." @default.
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• W2979154830 date "2012-10-01" @default.
• W2979154830 modified "2023-10-14" @default.
• W2979154830 title "Gastropericardial Fistula: A Life Threatening Complication after Esophagectomy" @default.
• W2979154830 doi "https://doi.org/10.14309/00000434-201210001-00593" @default.
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