title: Gastropericardial fistula after Roux-en-Y bypass for reflux disease.
abstract: 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.
authors.affiliation: Department of Upper GI Surgery, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Ajit
authors.identifier: http://orcid.org/0000-0003-0790-3045
authors.initials: A
authors.lastname: Dhillon
authors.affiliation: Department of Upper GI Surgery, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Amar M
authors.initials: AM
authors.lastname: Eltweri
authors.affiliation: Department of Radiology, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Vikas
authors.initials: V
authors.lastname: Shah
authors.affiliation: Department of Upper GI Surgery, Leicester Royal Infirmary, Leicester, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bowrey
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D018662:Fundoplication / Q000009:adverse effects; D005743:Gastrectomy; D005747:Gastric Fistula / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011026:Pneumopericardium / Q000473:pathology; D016896:Treatment Outcome