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Peer-reviewedCC BY 4.0International Journal of Emergency Medicine

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

  • Yasser Abdurabo Obadiel1
  • Mohammed Al-Shehari1
  • Aref Al-Hashedi2
  • Mansour Al-Hameli3
  • Nardeen Alqousi4
  • Anas Al-Kubati2
  • Abdullah Al-Kubati2
  • Bilal Sleiay5
  • Osama Al-Khawlani6
  • Majeed Shallan7
7 affiliations
  1. 1Department of Surgery, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
  2. 2Faculty of Medicine, 21 September University for Medical and Applied Sciences, Sana’a, Yemen
  3. 3Department of Radiology, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen
  4. 4Department of Surgery, Al-Thawra Modern General Hospital, Sana’a, Yemen
  5. 5Faculty of Medicine, Hama University, Hama, Syrian Arab Republic
  6. 6Faculty of Medicine, Sana’a University, Sana’a, Yemen
  7. 7Department of Anesthesiology and Intensive Care, 21 September University for Medical and Applied Sciences, Sana’a, Yemen
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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.

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Cite

BibTeXRIS
BibTeX
@article{obadiel2026esophagopericardial,
  title = {{Esophagopericardial fistula secondary to battery acid ingestion in a 3-year-old boy: a case report}},
  author = {Yasser Abdurabo Obadiel and Mohammed Al-Shehari and Aref Al-Hashedi and Mansour Al-Hameli and Nardeen Alqousi and Anas Al-Kubati and Abdullah Al-Kubati and Bilal Sleiay and Osama Al-Khawlani and Majeed Shallan},
  journal = {International Journal of Emergency Medicine},
  year = {2026},
  month = jul,
  doi = {10.1186/s12245-026-01332-9},
  url = {https://doi.org/10.1186/s12245-026-01332-9},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Esophagopericardial fistula secondary to battery acid ingestion in a 3-year-old boy: a case report
AU  - Yasser Abdurabo Obadiel
AU  - Mohammed Al-Shehari
AU  - Aref Al-Hashedi
AU  - Mansour Al-Hameli
AU  - Nardeen Alqousi
AU  - Anas Al-Kubati
AU  - Abdullah Al-Kubati
AU  - Bilal Sleiay
AU  - Osama Al-Khawlani
AU  - Majeed Shallan
PY  - 2026
DA  - 2026/07/31
JO  - International Journal of Emergency Medicine
DO  - 10.1186/s12245-026-01332-9
UR  - https://doi.org/10.1186/s12245-026-01332-9
AB  - 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.
SN  - 1865-1372
SN  - 1865-1380
ER  -