A case of gastropericardial fistula of a gastric tube after esophagectomy: a case report and review

Recent advances in thoracic surgery and post-surgical management in intensive care units (ICUs) have improved the survival of esophageal cancer patients after esophagectomy; many patients often survive more than five years. However, gastric tubes that replace esophagi may erode, leading to gastric tube cancer or perforated gastric tube ulcer. Complications after gastric tube ulcer depend on the posterior-mediastinal, retrosternal or subcutaneal location of the gastric tube. Perforated ulcers of gastric tubes in the posterior-mediastinal or retrosternal spaces, if they penetrate the neighboring trachea, thoracic aorta, or pericardium, are often lethal [1-4].We report here a rare rescued case of pericarditis due to gastropericardial fistula of the gastric tube ulcer after esophagectomy, and review 29 cases.A 65-year-old Japanese man was taken to National Hospital Organization Mito Medical Center by ambulance for severe colic right chest and back pain. He was lucid and body temperature was 36.7°C. His blood pressure was 127/97 mmHg, but atrial fibrillation (af), tachycardia, and ST-segment elevations in V5 and V6 were observed in the electrocardiogram (Figure 1A). Cardiomegaly was observed in the chest X-ray (Figure 1B). Severe inflammation was apparent, with a white blood cell (WBC) count of 9,100/μl and C-reactive protein (CRP) of 21.87 mg/dl (Table 1, left). He was hospitalized in the Department of Cardiology and conservatively treated with fluid replacement and anti-biotic chemotherapies (cefazolin). His condition worsened, with WBC and CRP increasing to 12,100/μl and 30.34 mg/dl, respectively, with liver and renal dysfunction (Table 1, right). Oxygen inhalation was required for worsening respiratory dysfunction, and he entered multi organ failure (MOF). Four days after admission, computed tomography (CT) showed pneumopericardium and a neighboring gastric tube that replaced the esophagus after esophagectomy (Figure 2A, B). The patient had a history of esophagectomy