Acute gastropericardial fistula with cardiac tamponade and septic pericarditis due to Helicobacter pylori–induced gastric ulcer perforation

Gastropericardial fistulas are pathological communications between the stomach and pericardium, often presenting late in course as a surgical emergency. These cases are exceedingly rare with a grim prognosis if not surgically corrected.1 Our case discusses a 65-year-old man who experienced acute-onset chest pain, bilateral shoulder pain, and a syncopal event prompting transfer to our level 1 regional medical center in obstructive shock with imaging concerning for gastropericardial fistula. Our case discusses the complex management of a critically ill patient's presentation, stabilization, and management.