Esophagopericardial Fistula With Survival

Abstract

<h3>To the Editor.—</h3> Causes of pneumopericardium, a rare intrathoracic lesion, were classified by Shackelford¹and by Meyer.²Stephenson et al³listed 13 cases, including his own cases, all with fatal outcome. Frey⁴described a fatal case due to extension of an ulcer in a hiatus hernia. The first reported survivor with this entity was a 6-year-old girl.⁵She had a perforated peptic ulcer of the esophagus with probable fistula formation to the pericardium. Romhilt⁶described a fatal case of perforation of an ulcer through the intrathoracic portion of the stomach, and this report describes survival of surgical repair of an open esophagopericardial fistula. <h3>Report of a Case.—</h3> A 72-year-old man had undergone surgical repair of a hiatus hernia four years previously. At that time, the diameter of the distal esophagus was found to be less than 1 cm, and surgical release of the stricture was