PT  - JOURNAL ARTICLE
AU  - Alexander Piszker
AU  - Nicholas McManus
AU  - Mark Foreman
TI  - Rare atypical presentation of a polymicrobial gastropericardial fistula
AID  - 10.1136/bcr-2022-250093
DP  - 2022 Sep 01
TA  - BMJ Case Reports
PG  - e250093
VI  - 15
IP  - 9
4099  - http://casereports.bmj.com/content/15/9/e250093.short
4100  - http://casereports.bmj.com/content/15/9/e250093.full
SO  - BMJ Case Reports2022 Sep 01; 15
AB  - 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.