Download PDF
Thorac Cardiovasc Surg 2005; 53(6): 365-367
DOI: 10.1055/s-2005-837705
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

Gastropericardial Fistula and Candida kruzei Pericarditis Following Laparoscopic Nissen Fundoplication (Gastropericardial Fistula)

F. Farjah2 , C. B. Komanapalli1 , I. Shen1 , M. S. Sukumar1
  • 1Department of Surgery, Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, OR, USA
  • 2Department of Surgery, University of Washington, Seattle, WA, USA
Further Information

Publication History

Received November 22, 2004

Publication Date:
28 November 2005 (online)

    Permissions and Reprints All articles of this category

Abstract

We report a case of gastropericardial fistula and Candida kruzei pericarditis one year after laparoscopic Nissen fundoplication. Chest X-ray and CT revealed pneumopericardium. Barium swallow, UGI, endoscopy, and bronchoscopy were negative. Pericardial exploration was performed through a sternotomy. Intraoperative fistulogram revealed a tract into the stomach. A midline abdominal incision allowed identification of the slipped Nissen, resection of the fistula tract, and subsequent re-do fundoplication. The patient was treated with amphotericin and remains symptom-free 10 months after her operation. We recommend both sternotomy and midline abdominal incisions to explore and access the pericardium, stomach, esophagus, and diaphragm.

Key words

Fistula - infection - pericardium - complications of surgery

References

  • 1 Bushin F L, Woodward E R, O'Leary J P. Occurrence of gastric ulcer after Nissen fundoplication.  Am Surg. 1976;  42 821-826
    PubMedGoogle Scholar
  • 2 Cozart J C, Sundaresan S, Chokshi H R, Aliperti G, Walden D T. Gastropericardial fistula with pneumopericardium: an unusual complication of benign peptic ulceration.  Gastrointest Endosc. 1999;  49 387-390
    CrossrefPubMedGoogle Scholar
  • 3 West A B, Nolan N, O'Briain D S. Benign peptic ulcers penetrating pericardium and heart: clinicopathological features and factors favoring survival.  Gastroenterology. 1988;  94 1478-1487
    CrossrefPubMedGoogle Scholar
  • 4 Murthy S, Looney J, Jaklitsch M T. Gastropericardial fistula after laparoscopic surgery for reflux disease.  N Engl J Med. 2002;  346 328-332
    CrossrefPubMedGoogle Scholar
  • 5 Schneider F, Schenk M, Tempe J D, Thiry L. Spontaneous gastropericardial fistula.  Ann Emerg Med. 1995;  26 394
    PubMedGoogle Scholar
  • 6 Kraus W E, Valenstein P N, Corey G R. Purulent pericarditis caused by Candida: report of three cases and identification of high-risk populations as an aid to early diagnosis.  Rev Infect Dis. 1988;  10 34-41
    PubMedGoogle Scholar
  • 7 Su-Gandarilla J, Guillem P, Herjean M, Triboulet J P. Gastropericardial fistula after failure of laparoscopic hiatal repair.  Dis Esophagus. 2000;  13 262-264
    CrossrefPubMedGoogle Scholar

M. Sukumar

OHSU Division of Cardiothoracic Surgery, Mailcode: L353

3181 SW Sam Jackson Park Road

Portland, Oregon 97239

USA

Phone: + 5034947820

Fax: + 50 34 94 78 29

Email: sukumarm@ohsu.edu

      >