Endoscopic vacuum assisted closure therapy for esophagopericardial fistula in a 16-year-old male: A case report

Figure 1 Axial chest tomography with contrast demonstrating a fistulous tract indicated by air density in the pericardium (white arrows) and the left pleural space with complex effusion (black arrows). Note the self-expandable metallic esophageal prosthesis (orange arrow) and the thoracostomy tube (yellow arrow).

Figure 2  Endoscopic vacuum assisted closure manufactured at the patient's bedside during endoscopy with Nélaton catheter, polyurethane sponge and silk sutures for fixation.

Figure 3 Serial endoscopic images of fistula closure. A: Initial upper gastrointestinal endoscopy for endoscopic vacuum assisted closure insertion, showing the esophageal opening leading to the fistulous tract of the pericardium and pleura (black arrow); B: The same opening 4 days later, with granulation tissue noted around the surrounding mucosa (black arrow); C: Fistula closed 15 days after device placement, with reduced inflammatory tissue and normalization of mucosa appearance (black arrow).