Esophagopericardial fistula: a late complication of liver stereotactic body radiation therapy.

Abstract

Esophagopericardial fistula (EPF) is an extremely rare, life-threatening condition that can develop following certain treatments. This case represents, to our knowledge, the first reported case of an EPF as a late complication of stereotactic body radiation therapy (SBRT) for liver metastases. It emphasizes the need for collaborative and individualized management strategies, particularly in the context of post-radiation tissue changes. A female patient in her late sixties, with a history of colon adenocarcinoma, previously treated with SBRT for liver metastases, presented with signs of cardiac tamponade. A multislice computed tomography (MSCT) scan confirmed EPF, and a multidisciplinary board was assembled to manage the patient. Initial management involved urgent pericardial drainage and vancomycin irrigation, followed by an endoscopic placement of a fully covered self-expandable esophageal metal stent. After the intervention, the patient's clinical condition significantly improved. The stent remained in place and maintained a stable position during a 6-month follow-up period. Given the rarity and diverse etiologies of EPF, it is essential to manage each case individually, taking into account prior interventions and the patient's healing capacities. Our experience highlights the importance of prompt hemodynamic stabilization, restoration of anatomical integrity, and a tailored approach to each patient. Specifically, permanent stent retention may be justified when radiation-impaired healing is present. Although EPF will remain uncommon, adherence to these principles, implemented through a multidisciplinary approach, can optimize outcomes when this severe complication does occur.