Gastropericardial fistula: a potential role for conservative treatment

Gastropericardial fistulae are rare entities associated with considerable mortality and morbidity. Most commonly seen secondary to surgery and trauma, they also occur because of peptic ulcer disease. Surgical correction remains the definitive treatment and conservative management is normally associated with poor outcomes. We present the case of a woman with multiple comorbidities who presented with a pneumopericardium secondary to a benign peptic ulcer-related gastropericardial fistula. This case shows that early nasojejunal feeding in patients not fit for a surgical intervention can be associated with a good outcome. We therefore propose that in cases where surgery is not feasible, conservative management with antibiotics and nasojejunal feeding remains a viable alternative.