{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T12:41:15Z","timestamp":1777725675939,"version":"3.51.4"},"reference-count":9,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,9,8]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>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\u2009year 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\u2009day after discharge.<\/jats:p>","DOI":"10.1136\/bcr-2022-250093","type":"journal-article","created":{"date-parts":[[2022,9,19]],"date-time":"2022-09-19T12:41:19Z","timestamp":1663591279000},"page":"e250093","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Rare atypical presentation of a polymicrobial gastropericardial fistula"],"prefix":"10.1136","volume":"15","author":[{"given":"Alexander","family":"Piszker","sequence":"first","affiliation":[{"name":"Graduate Medical Education, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA"},{"name":"Emergency Medicine, Mercy Health Partners, Muskegon, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"McManus","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Mercy Health Partners, Muskegon, Michigan, USA"},{"name":"Core Faculty, West Michigan Emergency Medicine Residency, Mercy Health Partners, Muskegon, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Foreman","sequence":"additional","affiliation":[{"name":"Internal Medicine, Mercy Health Partners, Muskegon, Michigan, USA"},{"name":"Associate Program Director, Internal Medicine Residency, Mercy Health Partners, Muskegon, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,19]]},"reference":[{"key":"2025082723163043000_15.9.e250093.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12876-016-0510-8","article-title":"Gastropericardial fistula: getting to the heart of the matter","volume":"16","author":"Azzu","year":"2016","journal-title":"BMC Gastroenterol"},{"key":"2025082723163043000_15.9.e250093.2","doi-asserted-by":"crossref","first-page":"801.e1","DOI":"10.1016\/j.ajem.2021.02.006","article-title":"Gastropericardial fistula induced acute purulent pericarditis","volume":"46","author":"Ni","year":"2021","journal-title":"Am J Emerg Med"},{"key":"2025082723163043000_15.9.e250093.3","first-page":"1","article-title":"Chest pain from pneumopericardium with gastropericardial fistula","volume":"2021","author":"Rathur","year":"2021","journal-title":"Case Rep Cardiol"},{"key":"2025082723163043000_15.9.e250093.4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/j.0954-6820.1983.tb03722.x","article-title":"Non-traumatic perforation of gastric ulcer in a hiatal hernia to the pericardium","volume":"213","author":"Sailing","year":"2009","journal-title":"Acta Med Scand"},{"key":"2025082723163043000_15.9.e250093.5","doi-asserted-by":"crossref","first-page":"435","DOI":"10.5811\/cpcem.2017.6.34372","article-title":"Gastropericardial fistula presenting 27 years after bariatric surgery","volume":"1","author":"Martin","year":"2017","journal-title":"CPC-EM"},{"key":"2025082723163043000_15.9.e250093.6","first-page":"371","article-title":"Gastropericardial fistula presenting 22 years after lye ingestion","volume":"21","author":"Susarla","year":"2005","journal-title":"Can J Cardiol"},{"key":"2025082723163043000_15.9.e250093.7","doi-asserted-by":"crossref","unstructured":"Lee J , Ramkumar S , Ha P , et al . Pyopneumopericarditis from a gastropericardial fistula: a case report. Euro Heart J - Case Rep 2021;5.doi:10.1093\/ehjcr\/ytab408","DOI":"10.1093\/ehjcr\/ytab408"},{"key":"2025082723163043000_15.9.e250093.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2010.09.082"},{"key":"2025082723163043000_15.9.e250093.9","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.jss.2016.03.015","article-title":"Gastropericardial fistula: radiologic findings and literature review","volume":"203","author":"Davidson","year":"2016","journal-title":"J Surg Res"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-250093","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:16:41Z","timestamp":1756361801000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-250093"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":9,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,19]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/bcr-2022-250093"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-250093","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}