Esophagopericardial fistula secondary to battery acid ingestion in a 3-year-old boy: a case report

Abstract

Abstract Background Esophagopericardial fistula (EPF) is an extremely rare and life-threatening condition associated with a high mortality rate, particularly when diagnosis and intervention are delayed. Here we present the case of a 3-year-old boy who developed EPF secondary to accidental battery acid ingestion. Case presentation A 3-year-old Yemeni boy presented with persistent epigastric pain, fever, and progressive dyspnea three weeks after accidental ingestion of battery acid, having initially received conservative supportive management at a regional hospital before delayed referral. Clinical examination revealed tachycardia, tachypnea, and a pericardial friction rub. Laboratory investigations demonstrated leukocytosis, severe thrombocytopenia, anemia, hypoalbuminemia, and markedly elevated inflammatory markers, consistent with sepsis. Imaging studies, including an iso-osmolar contrast swallow and CT, identified a 12-mm esophagopericardial fistula located in the distal esophagus, 2.5 cm above the gastroesophageal junction, accompanied by pyopneumopericardium. Following initial stabilization, the patient underwent a right posterolateral thoracotomy. Intraoperatively, gross inspection revealed extensive full-thickness ischemic necrosis and friability of the distal esophagus with inflammation extending to the pericardium, necessitating radical esophagectomy. The pericardium was opened, thoroughly irrigated with warm sterile saline, and a wide pericardial window was created for continuous drainage. An esophagectomy with gastric pull-up reconstruction was performed to achieve source control. Despite aggressive postoperative critical care, the patient developed refractory sepsis with multiorgan failure and died on the sixth postoperative day. Conclusion This case highlights the poor prognosis of esophagopericardial fistula following corrosive ingestion in children, especially with delayed presentation and subacute progression. Early recognition and immediate referral to specialized tertiary pediatric surgery centers are paramount.