Heartburn Takes a Whole New Meaning: Multidisciplinary Management of a Gastropericardial Fistula.

Gastropericardial fistulas (GCs) are exceedingly rare in the reported literature. Etiologies include prior abdominal surgery, malignancy, and perforated gastric ulcers. Presenting symptoms range from chest pain to cardiac tamponade. Early imaging can help delineate the origin of the fistula. Management involves a multidisciplinary team, involving endoscopic stenting for temporization followed by definitive surgery for fistula closure. Robotic, video-assisted thoracoscopic surgery (VATS) with pericardial window has only been reported once in modern literature as definitive management for GCs. Thus, we present a case of a gastro-pericardial fistula that was temporized with endoscopic stenting and surgically managed with right robotic VATS with a pericardial window and definitive fistula closure. The patient had presented in cardiac tamponade with initial imaging demonstrating a large, loculated hydropneumopericardium and GC. The patient's postoperative course was unremarkable, and she was discharged on postoperative day 7. Follow-up within our health system is currently 4.5 years, and she continues to do well.