Intragastric balloon causing gastropericardial fistula with pyopericardium

Area of Science:

• Gastroenterology and Cardiology
• Medical Device Complications

Background:

• Gastropericardial fistula (GPF) is a rare but serious complication of upper gastrointestinal procedures and conditions.
• GPF presents diagnostic challenges and has a high mortality rate, necessitating prompt recognition and management.
• Intragastric balloons (IGBs) are used for weight loss, but their potential complications are not fully elucidated.

Purpose of the Study:

• To report the first case of a gastropericardial fistula (GPF) caused by an intragastric balloon (IGB) during its recommended use.
• To highlight the diagnostic difficulties and successful management of this rare complication.

Main Methods:

• Case report of a male patient in his late 30s presenting with chest pain and sepsis.
• Utilized serial cross-sectional imaging for diagnosis.
• Managed the patient with definitive surgical intervention.

Main Results:

• The patient presented with symptoms mimicking acute coronary syndrome, a known presentation of GPF.
• Diagnosis of GPF was delayed due to the perceived safety of the IGB and persistent pericardial effusions.
• Successful recovery following surgical management.

Conclusions:

• Intragastric balloons (IGBs) can cause gastropericardial fistulas (GPFs), even during recommended treatment periods.
• Prompt diagnosis via advanced imaging and surgical intervention are critical for improving outcomes in GPF.
• This case underscores the importance of considering rare complications with medical devices.