PYOPNEUMOPERICARDITIS SECONDARY TO ENTERO-PERICARDIAL FISTULA: A RARE ETIOLOGY OF DYSPNEA

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Entero-pericardial fistulae are rare pathophysiologic communications between the gastrointestinal tract and the pericardium, most often a delayed complication of gastroesophageal surgeries. Despite aggressive multidisciplinary action, mortality rate remains >50%. Case An elderly female with remote history of Roux-en-Y gastric bypass and rheumatoid arthritis requiring chronic steroids presented with acute onset dyspnea. CT chest & esophagram demonstrated pneumopericardium (Figure 1). Esophagogastroduodenoscopy confirmed jejunal-pericardial fistula at the site of an ulcer distal to the gastro-jejunal anastomosis. Decision-making A pericardial drain was urgently placed, and subsequent cultures grew methicillin resistant Staphylococcus aureus (MRSA), Streptococcus parasanguinis, and Actinomyces odontolyticus. The patient underwent fistula take-down and was treated with a three-week course of vancomycin for MRSA and S. parasanguinis pericarditis and discharged with a 6-month course of amoxicillinclavulanate for Actinomyces pericarditis. A 3-month course of aspirin and colchicine was chosen for empiric coverage of pericarditis. Conclusion Entero-pericardial fistulas are often complicated by pneumopericardium, tamponade, and pericarditis that require prompt source control, broad spectrum antimicrobial coverage, and cardiovascular support. Despite multidisciplinary action and aggressive surgical and medical management, mortality remains high. [Formula presented]

Volume

83

Issue

13

First Page

4399

Find It @ Sladen

Share

COinS