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Rare atypical presentation of a polymicrobial gastropericardial fistula
  1. Alexander Piszker1,2,
  2. Nicholas McManus2,3 and
  3. Mark Foreman4,5
  1. 1Graduate Medical Education, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
  2. 2Emergency Medicine, Mercy Health Partners, Muskegon, Michigan, USA
  3. 3Core Faculty, West Michigan Emergency Medicine Residency, Mercy Health Partners, Muskegon, Michigan, USA
  4. 4Internal Medicine, Mercy Health Partners, Muskegon, Michigan, USA
  5. 5Associate Program Director, Internal Medicine Residency, Mercy Health Partners, Muskegon, Michigan, USA
  1. Correspondence to Dr Alexander Piszker;{at}


We present the unique case of a gastropericardial fistula with a rare, delayed presentation in a man in his 70s. Relevant surgeries include Watchman Left Atrial Appendage Closure device placement 1 year prior to arrival and gastric bypass surgery 20 years prior to arrival. The patient presented to the emergency department with weakness, diarrhoea and left knee pain. He was admitted for cellulitis of the left lower extremity, prosthetic septic arthritis of the left knee and group G streptococcus bacteraemia. His hospital course was complicated by acute chest pain and dyspnoea. Imaging revealed pneumopericardium. Oesophagogastroduodenoscopy visualisation confirmed the diagnosis of gastropericardial fistula. The patient could not be transferred to a tertiary centre for definitive management because of the effect of the COVID-19 pandemic on tertiary hospital volumes. After pericardial drainage and administration of antimicrobials without improvement, the patient was discharged to hospice care at his request and died 1 day after discharge.

  • Pericardial disease
  • Stomach and duodenum
  • Infectious diseases
  • Adult intensive care
  • Pneumomediastinum

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  • Contributors AP, MF and NM for writing and editing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.