Purulent Pneumopericardium From a Gastropericardial Fistula 30 Years After Gastrectomy.

BACKGROUND

Gastropericardial fistula is a rare and life-threatening complication, most often occurring in patients with prior gastric surgery and presenting with pneumopericardium and severe infection.

CASE SUMMARY: A 64-year-old man with a history of gastrectomy 30 years earlier presented with chest pain, dyspnea, and fever. Computed tomography demonstrated pneumopericardium with an air-fluid level, and pericardiocentesis yielded bile-tinged purulent fluid, findings strongly suggestive of a gastropericardial fistula. Despite broad-spectrum antimicrobial therapy and supportive care, the patient remained critically ill and left the hospital against medical advice. He died 2 weeks later from septic shock.

DISCUSSION: Gastropericardial fistula is diagnostically challenging given its rarity and nonspecific presentation. Pneumopericardium in patients with prior gastric surgery is a key diagnostic clue, and computed tomography is essential when echocardiography is limited by intrapericardial air.

TAKE-HOME MESSAGE: Gastropericardial fistula should be suspected in patients with pneumopericardium and prior gastric surgery, and early pericardial drainage is critical.