A 42-year-old man with no cardiac history underwent total gastrectomy with a Roux-en-Y reconstruction for a cardial adenocarcinoma classified pT3N0Mx. During the postoperative period, the patient experienced sharp and steady chest pain, with burning and inhibition of deep breaths, associated with fever, oxygen requirement and atrial fibrillation as shown on the electrocardiogram ( Fig. 1 ). Transthoracic echocardiography showed pericarditis without cardiac tamponade. A chest computed tomography (CT)-scan revealed pneumopericardium ( Fig. 2A ), hydropneumopericardium ( Fig. 2B , arrows) and pleural effusion ( Fig. 2B , dashed arrows). Simultaneously, ingestion of water-soluble medium via the nasogastric tube did not visualize any fistula. Nevertheless, according to the clinical, echocardiographic and radiologic findings and the previous surgery, an anastomotic leakage was suspected. The oesopericardial fistula was confirmed endoscopically. Pericardial surgical drainage was performed, removing purulent fluid with food fragments, and a covered stent was placed endoscopically over the fistula. Prolonged antibiotic therapy was administered. The patient remained well at 2 months, at which point the endoscopic control visualized good cicatrization of the fistula ( Fig. 2C ).
