title: Gastropericardial fistula as a delayed complication of a Nissen fundoplication.
abstract: A 41-year-old man presented to the emergency department with substernal chest pain and was found to have ST elevations in the inferior leads on his electrocardiogram. An emergent cardiac catheterization did not identify significant coronary narrowing. Computed tomography of the thorax demonstrated a pneumopericardium and a hiatal hernia. The patient had a complicated past surgical history, including a Nissen fundoplication and three additional surgeries for postoperative complications. An esophagram later revealed an ulcer and possible fistula, and the patient underwent gastropericardial fistula resection after the fistula failed to close with fibrin sealant application. Enteropericardial fistulas occur infrequently but have high morbidity and mortality rates. This possibility is much more likely in patients with prior gastroesophageal surgery, including laparoscopic Nissen fundoplication.
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
authors.forename: Kokila
authors.initials: K
authors.lastname: Kakarala
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
authors.forename: Hawa
authors.initials: H
authors.lastname: Edriss
authors.affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent