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February 25, 1974

Esophagopericardial Fistula With Survival

Author Affiliations

Mt. Carmel Medical Center Columbus, Ohio

JAMA. 1974;227(8):939. doi:10.1001/jama.1974.03230210049015

To the Editor.—  Causes of pneumopericardium, a rare intrathoracic lesion, were classified by Shackelford1 and by Meyer.2 Stephenson et al3 listed 13 cases, including his own cases, all with fatal outcome. Frey4 described 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.5 She had a perforated peptic ulcer of the esophagus with probable fistula formation to the pericardium.Romhilt6 described 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.

Report of a Case.—  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