Trattamento di fistola gastro-pericardica in pregressa esofagogastroplastica retrosternale per stenosi esofagea da caustici

Translated title of the contribution: Treatment of esophagopericardial fistula following esophagogastroplasty for esophageal caustic stenosis

Silvia Michieletto, Alberto Ruol, Matteo Cagol, Rita Alfieri, Carlo Castoro, Salvatore Marano, Chiara Tosolini, Ermanno Ancona

Research output: Contribution to journalArticlepeer-review

Abstract

Esophagopericardial fistula is a rare and severe complication, involving several benign, malignant and traumatic pathologies of the esophagus. Only few cases of esophagopericardial fistula have been published so far, as compared to more frequently reported cases of gastropericardial fistula. We report on a 25-year-old female with an esophagopericardial fistula following retrosternal esophagogastroplasty for esophageal caustic stenosis. One month before admission to our hospital, the patient had fever and nonradiating substernal chest pain which was relieved by aspirin, unfortunately without adequate antacid therapy. After 3 weeks, for abdominal pain and worsening chest pain with shock, she was admitted to another hospital and underwent laparotomy: an haemoperitoneum was found, due to a rupture of an ovarian cyst which was removed. For persistent shock, the patient had an echocardiogram which revealed a cardiac tamponade, treated with placement of a pericardic drainage (300 cc of purulent liquid). She was then transferred to our unit: an esophageal swallow with a small amount of methilene blue revealed a fistula between the stomach of the esophagogatroplasty and the pericardium. She eventually underwent surgery. A pericardial window was created, the gastric tube was taken down because of the impossibility to suture the gastric ulcer, and an esophagocoloplasty was used for the reconstruction of the alimentary transit. The postoperative course was uneventful. She is alive and well at 15 months after surgery. Esophagopericardial fistula is a rare complication, with a high mortality rate. A timely decision is mandatory and an aggressive treatment often necessary.

Translated title of the contributionTreatment of esophagopericardial fistula following esophagogastroplasty for esophageal caustic stenosis
Original languageItalian
Pages (from-to)243-246
Number of pages4
JournalAnnali Italiani di Chirurgia
Volume78
Issue number3
Publication statusPublished - May 2007

ASJC Scopus subject areas

  • Surgery

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