PMC5288955_01
65-year-old female presents with chest pain and shortness of breath 9 years after placement of a laparoscopic gastric band and was transferred to our institution for higher level of care following the results of a computed tomography. (a) Coronal contrast-enhanced computed tomography of the chest in the mediastinal window from an outside hospital shows a laparoscopic gastric band (arrow head) and partial visualization of an abscess adjacent to the gastric band (curved arrow). No direct communication with the pericardium was initially seen. (b) Axial image demonstrates pneumopericardium (arrow) and small pericardial effusion.
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F1
The patient was transferred from an outside hospital after computed tomography (CT) scan demonstrated a pericardial effusion, pneumoperitoneum, pneumopericardium, pulmonary embolism, and a dilated esophagus [Figure 1].
Single contrast upper gastrointestinal examination in the supine anteroposterior view shows increased phi angle and prominent gastric pouch (arrow) concerning for mild lap band slippage.
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F2
An upper gastrointestinal (UGI) examination performed at our hospital demonstrated an increased phi angle concerning for gastric band slippage but no definitive evidence of leak, perforation, or fistula [Figure 2].
Endoscopic image demonstrates an erosion of the lap band through the gastric wall (arrow).
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F3
On day three, the patient underwent an esophagogastroduodenoscopy that showed erosion of the gastric band into the stomach just distal to the lower esophageal sphincter [Figure 3].
(a) Coronal contrast-enhanced computed tomography shows collection of oral contrast within the pericardial sac (arrow). Communication between the inferior pericardial sac and a contrast-filled perigastric fluid collection is also seen (curved arrow). (b) Sagittal contrast-enhanced computed tomography showing fistulous tract between the perigastric fluid collection and the pericardial sac (arrow).
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F4
Oral contrast was noted layering in the pericardium [Figure 4].
Single contrast upper gastrointestinal in the anteroposterior view shows contrast extravasation into and layering along the inferior pericardial sac (arrow).
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F5
An additional UGI was performed to confirm a gastropericardial fistula [Figure 5].