Key result
A man in his 70s with a history of gastric bypass presented atypically with weakness and knee pain, and was ultimately diagnosed with a fatal polymicrobial gastropericardial fistula.
Case Report (n=1)
Highlights a rare, delayed presentation of a polymicrobial gastropericardial fistula in a patient with prior Watchman device placement and gastric bypass.
Indicates high mortality despite drainage in delayed gastropericardial fistula; extends sparse evidence on this complication after Watchman and gastric bypass.
We present the unique case of a gastropericardial fistula with a rare, delayed presentation in a man in his 70s. Relevant surgeries include Watchman Left Atrial Appendage Closure device placement 1 year prior to arrival and gastric bypass surgery 20 years prior to arrival. The patient presented to the emergency department with weakness, diarrhoea and left knee pain. He was admitted for cellulitis of the left lower extremity, prosthetic septic arthritis of the left knee and group G streptococcus bacteraemia. His hospital course was complicated by acute chest pain and dyspnoea. Imaging revealed pneumopericardium. Oesophagogastroduodenoscopy visualisation confirmed the diagnosis of gastropericardial fistula. The patient could not be transferred to a tertiary centre for definitive management because of the effect of the COVID-19 pandemic on tertiary hospital volumes. After pericardial drainage and administration of antimicrobials without improvement, the patient was discharged to hospice care at his request and died 1 day after discharge.
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Piszker et al. (2022) conducted a case report in Gastropericardial fistula (n=1). Pericardial window and antimicrobials was evaluated. A man in his 70s with a history of gastric bypass presented atypically with weakness and knee pain, and was ultimately diagnosed with a fatal polymicrobial gastropericardial fistula.
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