Gastric pericardial fistula in a bariatric patient

Bariatric surgery has positively affected the lives many by improving their overall health with weight loss. Unfortunately, there are complications to bariatric surgery including anastomotic leaks, bowel obstructions, hernias, and ulcers. We present a case report of a gastric-pericardial fistula in the setting of a marginal ulcer of a patient with prior Roux-en-Y gastric bypass (RNYGB).

The patient is a 71 year old female with a history of diabetes, hypertension, hypothyroidism and arthritis requiring many prior joint replacements and leaving the patient partially disabled requiring assistances daily. In addition, she had a RNYGB5 years prior to presentation. She presented to an outside hospital with shortness of breath, cough, and chest pain for 3 days prior. A CTA revealed pneumopericardium and small pericardial effusion.

She was transferred to us for VATS & EGD with CT surgery which revealed a pericardial gastric fistula. Bariatric surgery team was then consulted and discovered risk factors including smoking and NSAID use. Esophageal stent was placed by gastroenterology and as her course was complicated by COVID pneumonia requiring ICU transfer and intubation. Once recovered, surgical intervention was planned with bariatric surgery involving laparoscopic fistula takedown, gastrojejunostomy revision and G tube placement.

Gastric-pericardial fistula is a rare complication of bariatric surgery with a high mortality rate amongst the few cases reported. Early detection and multidisciplinary teamwork is necessary for good patient outcomes. It is important to emphasize risk factors for ulcers to patients and the serious complications that can occur.