2005 Volume 25 Issue 6 Pages 857-861
We report a case of constrictive pericarditis due to an esophagopericardial fistula occurring after radiation therapy for a germinoma of the thoracic cord. A 31-year-old man was admitted with respiratory distress and general edema. Chest radiography and computed tomography of the chest revealed bilateral pleural effusion and hydropneumopericardium. He underwent an emergency pericardiectomy and drainage under the diagnosis of constrictive pericarditis three days after admission. Postoperatively, his clinical condition improved markedly, but when he started oral intake, food was discharged from the pericardial drainage tube. An esophagogram demonstrated an esophagopericardial fistula just above the esophagogastric junction. Three days later, massive bleeding from the pericardial drain necessitated emergency surgery. Left lateral thoracotomy and laparotomy showed an esophagopericardial fistula just above the esophagogastric junction and bleeding from the inferior vena cava. The fistula was resected and the defect in the esophageal wall was closed with absorbable sutures. An omental pedicle was raised and fixed to the esophageal and venous walls, followed by feeding jejunostomy and drainage gastrostomy. Postoperative recovery was uneventful. One year after the operation, he has no gastrointestinal problems.
