Gastropericardial fistula and Candida kruzei pericarditis following laparoscopic Nissen fundoplication (gastropericardial fistula).
We report a case of gastropericardial fistula and Candida kruzei pericarditis one year after laparoscopic Nissen fundoplication. Chest X-ray and CT revealed pneumopericardium. Barium swallow, UGI, endoscopy, and bronchoscopy were negative. Pericardial exploration was performed through a sternotomy. Intraoperative fistulogram revealed a tract into the stomach. A midline abdominal incision allowed identification of the slipped Nissen, resection of the fistula tract, and subsequent re-do fundoplication. The patient was treated with amphotericin and remains symptom-free 10 months after her operation. We recommend both sternotomy and midline abdominal incisions to explore and access the pericardium, stomach, esophagus, and diaphragm.
Farjah
F
F
Department of Surgery, Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, OR, USA.
Komanapalli
C B
CB
Shen
I
I
Sukumar
M S
MS
D002177:Candidiasis / Q000209:etiology*; D005260:Female; D005402:Fistula / Q000209:etiology*; D018662:Fundoplication; D005747:Gastric Fistula / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D010493:Pericarditis / Q000209:etiology*; D010496:Pericardium; D011183:Postoperative Complications