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Introduction: Gastropericardial fistulas are rare conditions, with less than 100 reported cases. The diagnosis is associated with significant morbidity, prolonged hospitalization and often has a fatal outcome.

Case Presentation: We describe a unique case of cardiac arrest caused by pneumopericardium and cardiac tamponade as the acute presentation of a gastropericardial fistula, in a patient admitted with an infection of unknown origin.

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Pneumopericardium is a rare but serious cause of morbidity and mortality. Untreated, it can lead to cardiac tamponade and thus must be promptly identified to treat the underlying etiology. Here, we report a case of spontaneous pneumopericardium secondary to gastric ulcer perforation in association with a hiatal hernia.

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A patient operated for carcinoma of the bladder complicated by infection by anaerobic organisms developed pneumopericardium. Spontaneous pneumopericardium may or may not follow effraction of the pericardium. The following causes have been described: fistula with a tuberculous cavernoma, parenchymatous or pleural infection, carcinoma of the bronchus; oesophageal or gastro-pericardial fistulae arising from carcinoma or ulceration of the stomach or oesophagus; rupture of a mediastinal, hepatic or subphrenic abscess and, exceptionally, pericarditis complicated by fistulisation to the tracheo-bronchial tree.

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