Intragastric balloon causing gastropericardial fistula with pyopericardium

Gastropericardial fistula (GPF) is a rare complication of oesophagogastric operations, including bariatric procedures. Non-surgical causes include upper gastrointestinal malignancy or peptic ulcer disease. GPF requires prompt recognition and intervention but poses diagnostic difficulties, which contributes to its high mortality. This is the first reported case of a GPF caused by an intragastric balloon (IGB) during the recommended treatment period. This case describes a male patient in his late 30s presenting with chest pain and sepsis. ECG and troponin levels suggested an acute coronary syndrome, a common presentation of GPF. He had persistent pericardial effusions and severe infection, but the perceived safety of IGB delayed the GPF diagnosis, which was reached with serial cross-sectional imaging. The patient recovered well with definitive surgical management, the mainstay of treatment, which drastically reduces mortality of GPF.