Purulent pericarditis with esophagopericardial fistula secondary to metastatic colon disease is uncommon. Current reports in the literature describe successful palliation via endoluminal esophageal stent insertion. We present our management strategy for a difficult case in which (complete) esophageal occlusion by tumor burden precluded endoscopic passage of the guide wire required to successfully perform such a procedure. Simple tube pericardiostomy is presented as an alternative procedure that produced a satisfactory outcome. This surgical procedure is an appropriate palliative alternative when an endoscopic procedure is not feasible, and is much less invasive than the surgical palliative procedures reported in the literature.
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