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


COD: 243-246 Categorie: ,

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

Ann. Ital. Chir., 2007; 78: 243-246

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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.