Pneumopericardium Secondary to Jejunopericardial Fistula.

Pneumopericardium is an uncommon condition characterized by the presence of air within the pericardial sac and may rarely progress to cardiac tamponade. A patient with a history of Roux-en-Y gastric bypass presented with chest pain, dyspnea, and hemodynamic instability. Imaging demonstrated a large pneumopericardium with tamponade physiology. Further evaluation revealed a rare jejunopericardial fistula as the underlying etiology, resulting in communication between the gastrointestinal tract and pericardial space. Emergent pericardial decompression was performed with clinical improvement. This case highlights an unusual late complication of bariatric surgery and underscores the importance of prompt recognition, diagnostic imaging, and timely intervention in patients presenting with pneumopericardium and circulatory compromise.