Abstract

Case Report

Pneumopericardium: A Rare Complication of Antireflux Surgery

Diquas Elisabeth, Druez Anne and Dili Alexandra*

Published: 23 August, 2023 | Volume 8 - Issue 2 | Pages: 104-107

Pneumopericardium is a rare clinical entity, occurring in the setting of thoracic trauma, malignancies, or mechanical ventilation. Very few cases report pneumopericardium as a complication of gastrointestinal tract surgery. Signs and symptoms may be frustrating, ranging from asymptomatic to chest pain, sepsis, hemodynamic instability, pericarditis, or even cardiac tamponade. Clinical pathognomonic signs of pneumopericardium include pericardial metallic tinkling friction rub and mill wheel murmur. Diagnostic work-up includes electrocardiogram, chest radiography, and, computed tomography imaging. A gastro pericardial fistula should be considered a rare differential diagnosis for acute chest pain in patients with a history of gastroesophageal surgery. Rapid recognition and treatment avoid life-threatening complications. The successful outcome of gastro pericardial fistula treatment depends on both emergency and definitive surgical management. The survival rate with conservative management is poor.
We present the case of a 78-year-old patient suffering from pneumopericardium and pericardial infusion, due to a fibrotic fistula between the Nissen’s valve, occurring 10 years after redo antireflux surgery. Treatment included broad-spectrum antibiotics, and emergency surgery for pericardial drainage, biopsy of the valve’s defect, suture, and omentoplasty.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001161 Cite this Article Read Full Article PDF

Keywords:

Pneumopericardium; Gastro pericardial fistula; Nissen fundoplication

References

  1. Grandhi TM, Rawlings D, Morran CG. Gastropericardial fistula: a case report and review of literature. Emerg Med J. 2004 Sep;21(5):644-5. doi: 10.1136/emj.2003.007765. PMID: 15333561; PMCID: PMC1726431.
  2. Liu W, Syngal S, Zellos L. Gastropericardial fistula-induced pericarditis: an unusual consequence of GERD. Medscape J Med. 2008;10(9):205. Epub 2008 Sep 2. PMID: 19008967; PMCID: PMC2580078.
  3. Bianchi Pintos DM, Bergoglio H, Dours JJ, Argazùa M, Vignau C, Polo S. Cardiac auscultation in the pneumopericardium. Argentine Journal of Cardiology. 2019; 87: 65-66. http://www.scielo.org.ar/pdf/rac/v88n1/en_1850-3748-rac-88-01-69.pdf
  4. Azzu V. Gastropericardial fistula: getting to the heart of the matter. BMC Gastroenterol. 2016 Aug 19;16(1):96. doi: 10.1186/s12876-016-0510-8. PMID: 27542946; PMCID: PMC4992300.
  5. Imran Hamid U, Booth K, McManus K. Is the way to a man's heart through his stomach? Enteropericardial fistula: case series and literature review. Dis Esophagus. 2013 Jul;26(5):457-64. doi: 10.1111/j.1442-2050.2012.01373.x. Epub 2012 Jun 7. PMID: 22676713.
  6. Ni B, Chen YL, Lin PC, Hou YT, Ho YT, Wu MY. Gastropericardial fistula induced acute purulent pericarditis. Am J Emerg Med. 2021 Aug;46:801.e1-801.e3. doi: 10.1016/j.ajem.2021.02.006. Epub 2021 Feb 10. PMID: 33608167.
  7. Anand R, Brooks Md Facs SE, Puckett Y, Richmond RE, Ronaghan CA. Pneumopericardium Resulting From Blunt Thoracic Trauma. Cureus. 2020 Nov 22;12(11):e11625. doi: 10.7759/cureus.11625. PMID: 33376639; PMCID: PMC7755601.
  8. Sihvo EI, Räsänen JV, Hynninen M, Rantanen TK, Salo JA. Gastropericardial fistula, purulent pericarditis, and cardiac tamponade after laparoscopic Nissen fundoplication. Ann Thorac Surg. 2006 Jan;81(1):356-8. doi: 10.1016/j.athoracsur.2004.08.048. PMID: 16368406.
  9. [9] Pop, D., Venissac, N., Rami, L., Mouroux, J. (2007) Gastropericardial fistula after laparoscopic surgery for gastroesophageal reflux disease. Journal of thoracic and cardiovascular surgery, 133 (6), 1676-1677. http://doi.org/1016/j.jtcvs.2007.02.009
  10. Farjah F, Komanapalli CB, Shen I, Sukumar MS. Gastropericardial fistula and Candida kruzei pericarditis following laparoscopic Nissen fundoplication (gastropericardial fistula). Thorac Cardiovasc Surg. 2005 Dec;53(6):365-7. doi: 10.1055/s-2005-837705. PMID: 16311974.
  11. Ataya A, Zellers P, Mitchell J, Alraies MC. An unusual cause of pneumopericardium. J Am Coll Cardiol. 2012 Oct 16;60(16):e29. doi: 10.1016/j.jacc.2012.03.082. PMID: 23058319.
  12. Lazopoulos G, Kalogerakos P, Kampitakis E, Pavlopoulos D, Kiparakis M, Chalkiadakis G. Tension hydropneumopericardium following laparoscopic Nissen fundoplication. J Card Surg. 2016 Sep;31(9):589. doi: 10.1111/jocs.12800. Epub 2016 Jul 8. PMID: 27389076.
  13. Murthy S, Looney J, Jaklitsch MT. Gastropericardial fistula after laparoscopic surgery for reflux disease. N Engl J Med. 2002 Jan 31;346(5):328-32. doi: 10.1056/NEJMoa010259. PMID: 11821509.
  14. Hauters P, de Canniere L, Collard JM, Buysschaert M, Michel LA. Gastrodiaphragmatic fistula after transabdominal Nissen fundoplication. An unusual complication. J Clin Gastroenterol. 1990 Jun;12(3):313-5. doi: 10.1097/00004836-199006000-00017. PMID: 2362102.
  15. Mansour KA, Sharma J. Delayed intrathoracic rupture of herniated Nissen fundoplication: report of two cases. Ann Thorac Surg. 2003 Jun;75(6):1957-9. doi: 10.1016/s0003-4975(02)04840-3. PMID: 12822646.
  16. Ikard RW, Jacobs JK. Gastropericardial fistula and pericardial abscess: unusual complications of subphrenic abscess following Nissen fundoplication. South Med J. 1974 Jan;67(1):17-9. doi: 10.1097/00007611-197401000-00006. PMID: 4808980.
  17. de Bruyne B, Dugernier T, Goncette L, Reynaert M, Otte JB, Col J. Hydropneumopericardium with tamponade as a late complication of surgical repair of hiatus hernia. Am Heart J. 1987 Aug;114(2):444-6. doi: 10.1016/0002-8703(87)90522-9. PMID: 3604908.
  18. Kalder J, Köster H, Hellinger A. Gastro-pericardial fistula as an early complication after surgery for combined paraesophageal and hiatal hernia. Thorac Cardiovasc Surg. 2006 Feb;54(1):67-9. doi: 10.1055/s-2005-865903. PMID: 16485195.
  19. Edwards JR, Humeniuk V. Gastropericardial fistula. Aust N Z J Surg. 1996 Apr;66(4):257-9. doi: 10.1111/j.1445-2197.1996.tb01176.x. PMID: 8611135.
  20. Kakarala K, Edriss H, Nugent K. Gastropericardial fistula as a delayed complication of a Nissen fundoplication. Proc (Bayl Univ Med Cent). 2015 Oct;28(4):478-81. doi: 10.1080/08998280.2015.11929314. PMID: 26424947; PMCID: PMC4569230.
  21. Chen JS, Hal HM, Tappouni RF. Radiologic evaluation of postoperative gastropericardial fistula. Radiol Case Rep. 2015 Nov 6;9(3):952. doi: 10.2484/rcr.v9i3.952. PMID: 27186253; PMCID: PMC4861863.
  22. Misenheimer JA, Liu Y, Means G, Kaul P, Yeung M. Tension Pneumopericardium Secondary to Gastropericardial Fistula Presenting as Acute Pericarditis With Cardiac Tamponade Physiology. JACC Cardiovasc Interv. 2016 Aug 22;9(16):1748-9. doi: 10.1016/j.jcin.2016.05.042. PMID: 27539697.
  23. Schneider F, Schenk M, Tempé JD, Thiry L. Spontaneous gastropericardial fistula. Ann Emerg Med. 1995 Sep;26(3):394. doi: 10.1016/s0196-0644(95)70100-1. PMID: 7661443.

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?