A 73-year-old man presented with chest pain and shortness of breath. He received esophageal reconstruction with gastric tube via retrosternal route five years ago due to gastroesophageal reflux disease (GERD) and severe esophageal stricture. At emergency department, the chest radiography and computed tomography (CT) disclosed abnormal air and fluid collection in the pericardial cavity. Under the impression of hollow organ perforation into the pericardial cavity, the patient received emergent pericardiectomy to relieve the cardiac tamponade. Surgery revealed a fistula between the pericardial cavity and the reconstructed gastric tube. Total gastrectomy, feeding duodenostomy and pericardial drainage were performed in the operation. After surgical intervention, the patient recovered uneventfully and was discharged 3 weeks later.