Abstract

Gastropericardial fistula is a life-threatening complication which results from a communication between the stomach and the pericardium. The resulting cardiac tamponnade and shock can lead to death. We present an unusual case of a 55 year-old woman who was found to have pericardial and bilateral pleural effusion on CT-scan and US imaging post-gastric bypass surgery. Endoscopy and contrast imaging showed that a fistula had developed from ischemia of the proximal eso-jejunal suture, which resulted in a para-gastric abscess communicating with pericardial and pleural spaces in the thoracic cavity. She developed ARDS and hypovolemic shock and was admitted to the ICU. Deployment of a synthetic trans-oral prosthesis endoscopically allowed tight exclusion of the fistula from the luminal cavity. A positive type Streptococcus as well as Candida albicans were respectively identified in the fluid specimen during surgical drainage. Broad spectrum antibiotics and anti-fungal agents were administered together with colchine and aspirine for pericarditis treatment. She managed to leave hospital on day 58 with a follow-up appointment 4 weeks after.

Keywords: Gastric Bypass Surgery; Pericarditis; Fistula; Endoscopic Fistula Treatment; Plastic Prosthesis; Obesity Treatment

References

1. Azzu V. “Gastropericardial fistula. Getting to the heart of the matter”. BMC Gastroenterology 96 (2016): 1-5.
2. Davidson JP., et al. “Gastropericardial fistula: radiologic findings and literature review”. Journal of Surgical Research 203 (2016): 174-182.
3. Chen JS., et al. “Radiologic evaluation of post-operative gastro-pericardial fistula”. Radiology Case Reports 9.3 (2014): 1-4.
4. Martin RA, et al. “Gastropericardial Fistula presenting 27 years after Bariatric Surgery”. Clinical Practice and Cases in Emergency Medicine 1.4 (2017): 435-436.
5. Hamid UI., et al. “Closure of bronchopleural fistula using glue”. Interactive Cardiovascular and Thoracic Surgery 13 (2011): 117-118.
6. Kariyanna., et al. “Esophago-pericardial Fistula Incuded Community Acquired Methicillin Resistant Staphylococcus Aureus (CA-MRSA) Cardiac Tamponade – A Rare Case Report and Literature Review”. American Journal of Medical Case Reports (2018): 109-113.

Citation

Citation: Avinash Jayaswal and Mohamed El Koulali. “Fistula-Related Pericarditis as a Complication of Gastric Bypass Surgery”. Acta Scientific Gastrointestinal Disorders 3.3 (2020): 01-03.

Copyright

Copyright: © 2020 Avinash Jayaswal and Mohamed El Koulali. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.