Gastropericardial fistula

Last revised by Arlene Campos on 7 May 2024

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.

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 gastroesophageal surgery or endoscopy history.

Patients may also present with septicemia.

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

Gas within the pericardium surrounding the heart (pneumopericardium).

Contrast within the stomach, either ingested or installed through a feeding tube (PEG tube), can be seen leaking outside the stomach and reaching the pericardial sac

Although the effect of oral contrast medium 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 helps identify the fistula.

CT can also detect pneumopericardium and underlying etiologies like gastric tumors. 

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 prognoses.

Gastropericardial fistula was reported for the first time in 1947 by Harp and Peeke 4.

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