ESOPHAGEAL FISTULA AND SYNCOPE: A CASE OF CARDIAC TAMPONADE AFTER AN ESOPHAGOGASTRODUODENOSCOPY

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: We present a rare case of cardiac tamponade and suppurative pericarditis with large pneumopericardium following an esophagogastroduodenoscopy (EGD), which diagnosed esophageal fistula. CASE PRESENTATION: 59-year-old female mesothelioma treated left pleurodesis-decortication, radiation chemotherapy presented for EGD to work-up several month history dysphagia post-prandial emesis chest pain, dizziness palpitations after CT scan had shown marked distal circumferential thickening.EGD demonstrated 5cm fistula, above the gastroesophageal junction (Fig 1) at point she was admitted further management. On hospital day 2, rapid response (RRT) called syncope, tachycardia, hypotension, lactic acidosis. She resuscitated IV fluids started on broad spectrum antimicrobials presumed sepsis. Later in day, another RRT similar symptoms. angiogram showed new esophageal-pericardial fistula (EPF) resulting pericardial effusion evidence right heart strain 2). then ICU where drain placed significant purulent drainage (>500cc) cultures revealing polymicrobial gut flora, tube improvement her hemodynamics. 3, repeat attempted stent placement, but as probe passed area EPF, suffered PEA arrest. ROSC achieved 2 minutes procedure aborted. later extubated deemed too high-risk second attempt expansion subsequent radiographs 3). The patient elected enter hospice discharged from ICU. DISCUSSION: Pneumopericardium is finding usually described newborns, trauma, or iatrogenic due cardiothoracic procedures (1). Rarely has been reported secondary GI manipulation cancer (2). Hirani et al. 2020 series identified 11 cases cancer-related over 10-year period most (9/11) related solid lung esophagus malignancies, including 5/11 were EPF (3). Cardiac infrequent complication leading high mortality (1) initial treatment involving pericardiocentesis followed by placement (1,3).In our patient, biopsy pathology samples taken during revealed likely therapy-related changes that predisposed developing EPF. CO2 insufflation required instilled "air" through presentation CONCLUSIONS: can lead pneumoperitoneum causing morality despite early diagnosis treatment. REFERENCE #1: S, Cancer-Related Pneumopericardium: A Report Literature Review. Rep Oncol. 2020;13(1):23-28.2. #2: Takayama T, Okura Y, Funakoshi K, Sato Ohi H, Kato T. Esophageal esophagopericardial pericarditis. Intern Med. 2013;52(2):243-247. #3: Tombazzi C, Marino G, Yong J, Vallejo V, Reddy K. Malignant presenting tamponade. Dig Dis Sci. 2006;51(7):1290-1293. DISCLOSURES: No relevant relationships Bahaadin Al-Jarani, source=Web Response Leslie Kao, Advisory Committee Member relationship Jazz Pharmaceuticals Please note: $1-$1000 Stephen Pastores, Response, value=Consulting fee Grant Support Clinical Trial Biomerieux $5001 - $20000 value=Grant/Research Zuhair Salah,