Gastropericardial fistulas are rare abnormal communications between the stomach and the pericardial sac. This is a life-threatening condition that can lead to impaired cardiac function, sepsis and eventually death.
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Clinical presentation
Patients with gastropericardial fistula may present with non-specific symptoms such as chest and epigastric pain, shortness of breath or palpitation. The suspicion for such diagnosis should be raised if these symptoms are associated with a recent history of gastroesophageal surgery or endoscopy.
Patients may also present with septicemia.
Pathology
Gastropericardial fistula usually occurs within a hiatus hernia rather than occurring transdiaphragmatically. Different etiologies may predispose to gastropericardial fistula, such as:
- gastric surgery
- gastric tumors
- perforated gastric ulcer
- trauma, e.g upper gastrointestinal endoscopy
- foreign body
- corrosive ingestion
Radiographic features
Plain radiography
Gas within the pericardium surrounding the heart (pneumopericardium).
Fluoroscopy
Contrast within the stomach; either ingested or installed through feeding tube (PEG tube), can be seen leaking outside the stomach and reaching the pericardial sac
CT
Although oral contrast medium effect on the pericardium is controversial, CT with oral contrast is considered the most sensitive imaging modality for diagnosis. The use of oral contrast enhances the visualization of the fistulous track. Multi-planar reconstruction is helpful to identify the fistula.
CT also can detect pneumopericardium and underlying etiologies like gastric tumors.
Treatment and prognosis
Surgical closure of the fistulous track is considered the treatment of choice. Patients presenting with impaired cardiac function and other comorbidities such as underlying cancer and old age have poor prognosis.
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