Gastropericardial fistula is an extremely rare condition with very few cases reported worldwide, and no consensus on management exists.


Our patient is a 55-year-old male with a history of roux-en-y gastric bypass. He presented to an outside hospital with chest pain and chills, and was diagnosed with a gastropericardial fistula from a perforated marginal ulcer. He underwent a pericardial window with drain placement, but was transferred to our facility after no clinical improvement. Upon arrival, he was taken to the operating room and covered stents were placed with a plan for eventual esophagojejunostomy. He stabilized, however, he was diagnosed with intrahepatic cholangiocarcinoma during the admission and elected to be discharged with hospice care.


A literature review by Hamid et al. discovered 95 reported cases of enteropericadial fistula along with their treatment. Their review noted success in treatment of the condition with management by conduit tissue transposition. Definitive plan for our patient was resection of the involved tissue with esophagojejunostomy. As he presented malnourished and deconditioned, he would likely not have been able to tolerate this, and covered stents were placed as a temporizing measure. Though the patient was discharged to hospice care, he was in stable clinical condition and tolerating diet.


There exists no consensus on the optimal management of enteropericardial fistulas. Covered stents as a bridge to definitive therapy may be a treatment strategy as they are safe and easy to perform in the acute setting by many gastroenterologists or gastrointestinal surgeons.