Background

Bariatric surgery has positively affected the lives many by improving their overall health with weight loss. Unfortunately, there are complications to bariatric surgery including anastomotic leaks, bowel obstructions, hernias, and ulcers. We present a case report of a gastric-pericardial fistula in the setting of a marginal ulcer in a patient with prior roux-en-y gastric bypass.

Methods

The patient is a 71 year old female with a history of diabetes, hypertension, hypothyroidism and arthritis requiring many prior joint replacements, leaving the patient partially disabled requiring assistances with activities of daily living. In addition, she had a prior roux-en-y gastric bypass 5 years prior to presentation. She presented to an outside hospital with shortness of breath, cough, and chest pain for 3 days prior. A CTA revealed pneumopericardium and small pericardial effusion. VATS & EGD with cardiothoracic surgery revealed evidence of a gastric pericardial fistula. The bariatric surgery team was then consulted and discovered risk factors including smoking and NSAID use. An esophageal stent was placed by gastroenterology and her course was complicated by COVID pneumonia requiring ICU transfer and intubation. Once recovered, surgical intervention with bariatric surgery involved laparoscopic fistula takedown, gastrojejunostomy revision and G tube placement. She recovered well.

Conclusions

Gastric-pericardial fistula is a rare complication of bariatric surgery with a high mortality rate amongst the few cases reported. Early detection and multidisciplinary teamwork is necessary for good patient outcomes. It is important to emphasize risk factors for ulcers to patients and the serious complications that can occur