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CASE REPORT
Gastropericardial fistula after Roux-en-Y bypass for reflux disease
  1. Ajit Dhillon1,
  2. Amar M Eltweri1,
  3. Vikas Shah2,
  4. David J Bowrey1
  1. 1Department of Upper GI Surgery, Leicester Royal Infirmary, Leicester, UK
  2. 2Department of Radiology, Leicester Royal Infirmary, Leicester, UK
  1. Correspondence to Ajit Dhillon, ajitdhillon{at}doctors.org.uk

Summary

A 49-year-old man was admitted to his local hospital with a 3-day history of left-sided chest pain which started after a coughing paroxysm. His surgical history included laparoscopic Toupet fundoplication 30 months earlier and revisional reflux surgery (Roux-en-Y gastric bypass) 11 months earlier. On admission, he was found to be tachycardic at 110 bpm, hypotensive (90/65 mm Hg). He had ST depression in ECG leads V2-5 with a normal troponin I level. Chest radiography indicated a pneumopericardium which prompted referral to the oesophagogastric surgery unit. Endoscopy and CT with oral contrast confirmed a gastropericardial fistula. This was managed by total gastrectomy through a left thoracoabdominal approach. The patient was discharged home 2 months later. We report the fourth case of gastropericardial fistula in the literature as a long-term complication of Roux-en-Y gastric bypass with a favourable outcome and mini literature review.

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