Gastropericardial fistula in a patient with upside-down stomach and stomach perforation: a case report

Abstract

Background

Gastropericardial fistula is a pathological communication between the stomach and the pericardium. This case report describes a gastropericardial fistula in a patient with upside-down stomach.

Case presentation

The male patient (86) was examined for severe chest pain behind the sternum. CT revealed upside-down stomach with perforation on the lesser gastric curvature and fistulation into the pericardium with pneumopericardium. The patient was indicated for surgery. The procedure was performed from a transverse laparotomy and consisted of repositioning the stomach into the abdominal cavity, resection of the hernial sac, suture of the perforation of the lesser curvature, gastropexy and transhiatal drainage of the mediastinum and lesser sac. In the early postoperative period, the recovery was uneventful. Acute myocardial infarction with cardiorespiratory failure developed on the postoperative day (POD) 13. The patient died on POD 24 due to cardiorespiratory failure, confirmed by a sectional finding.

Conclusions

Gastropericardial fistula is a rare acute complication of the diseases of the upper GIT. It is invariably a serious, life-threatening condition. Diagnosis is confirmed by thoracic CT and a contrast swallow study. The necessity of acute surgical treatment is widely accepted. The type of procedure must be selected based on the patient's individual criteria.

Keywords:

• Upside-down stomach surgery
• gastropericardial fistula
• hiatal hernia
• gastric perforation

Authors' contributions

R.V. contributed as main author of the manuscript, provided literary review, discussion and final corrections of the manuscript. M.G. and L.H. contributed to the collection of the data and literature search. K.V. and M.S. contributed to the correction of the text, discussion and literary review and final correction and Č.N. contributed to the discussion. All authors read and approved the final manuscript.

Ethical approval

Ethical committee of University Hospital Olomouc approved the case study for publication. Informed consent on the indication of surgery and perioperative care was undersigned by the patient (as a part of standard documentation).

Disclosure statement

The authors declare that they have no competing interests.

Availability of data and materials

We state that data and materials are available for eventual revision.