Gastropleural fistula in a case of tubercular empyema thoracis

A 40-year-old gentleman presented to our institution with complaints of persistent discharge of ingested food particles via left-sided open window thoracostomy site for last 3 days. Open window thoracostomy was done outside for chronic tubercular empyema thoracis, which was not responding to tube thoracostomy and anti-tubercular medications. Contrast-enhanced computerized tomographic scan (CECT) of the thorax and abdomen revealed fistulous communication between the stomach and left-sided pleural cavity. Endoscopy of the upper gastrointestinal tract showed normal esophagus with internal opening at the fundus of stomach. We deferred any major surgical intervention in view of infected thoracostomy site, anticipated difficulty in primary repair, and poor nutritional status of the patient. Patient responded to low pressure suction through thoracostomy site, nutritional support, and anti-tubercular medication via feeding jejunostomy. This case highlights the fact that gastropleural fistula—a rare surgical entity may occur with different possible etiopathogenesis and probably in our case it has developed due to either inadvertent placement of suture through the gastric wall or iatrogenic perforation during open window thoracostomy.