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This case describes a male patient in his late 30s presenting with chest pain and sepsis. ECG and troponin levels suggested an acute coronary syndrome, a common presentation of GPF. He had persistent pericardial effusions and severe infection, but the perceived safety of IGB delayed the GPF diagnosis, which was reached with serial cross-sectional imaging. The patient recovered well with definitive surgical management, the mainstay of treatment, which drastically reduces mortality of GPF.<\/jats:p>","DOI":"10.1136\/bcr-2024-261640","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T13:59:01Z","timestamp":1746626341000},"page":"e261640","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Intragastric balloon causing gastropericardial fistula with pyopericardium"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0984-896X","authenticated-orcid":false,"given":"Christina","family":"Plowman","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Barts and The London NHS Trust, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seema","family":"Yalamanchili","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Barts and The London NHS 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