Gastropericardial fistula as a late complication of Roux-en-Y procedure.

Pneumopericardium secondary to gastro-pericardial fistula is a rare complication associated with various surgical procedures and conditions, notably Roux-en-Y gastric bypass. This condition poses a risk of cardiac tamponade and can be fatal if not promptly diagnosed and managed. We present a case of a 62-year-old female with a history of gastric bypass who presented with nonspecific symptoms and was eventually diagnosed with pneumopericardium secondary to gastro-pericardial fistula. Despite efforts for timely intervention, including transfer to a facility with cardiothoracic surgery availability, the patient's unstable condition precluded surgical intervention, leading to her eventual demise. A literature review reveals that the average time from Roux-en-Y gastric bypass surgery to presentation is nine years. The elusive nature of the presentation underscores the importance of a comprehensive clinical history in identifying this condition early. Awareness of gastro-pericardial fistula as a potential late complication of gastric bypass is crucial for timely diagnosis and intervention to improve patient outcomes.