Hernández-Avendaño V, López RA, Jiménez-López M

Language: Spanish
References: 11
Page: 72-76
PDF size: 289.74 Kb.

ABSTRACT

Introduction: Achalasia is defined as the absence of peristalsis in the distal esophagus, with abnormal relaxation of the lower esophageal sphincter. It is classified as primary and secondary according to its etiological cause. The main symptoms are: Dysphagia, heartburn, retrosternal pain and weight loss. In those patients that persist with symptomatology after surgical management, an endoscopic approach could be considered. There is no clear criteria on the proper management if symptoms persist after surgical or endoscopic approaches. We present the case of a patient with achalasia with three attempts of resolution that were not successful. Case report: A 29-year-old male who was diagnosed with esophageal achalasia in September 2017. He is submitted to a laparoscopic cardiomyotomy on two occasions on September and December of the same year. He was derived to this unit for oral endoscopic myotomy in February 2018. Seven days after the procedure was performed he is admitted in our unit due to the presence of retrosternal pain, fever, leukocytosis, chest X-ray with left pleural effusion of 60% and an oral contrast study was inconclusive for perforation. It was then decided to perform a laparoscopic exploratory procedure. The transoperative findings were: Absence of a perforation and the distal third of the esophagus with complete circular muscle fibers. It was decided to perform a classic Heller cardiomyotomy and placement of a left chest tube. A contrast study was requested 72 hours later without abnormal findings reported, therefore oral intake was started, removal of the chest tube on the 6th day and discharge on postoperative day seven. Conclusions: There is no stablished route guide in the case of the persistence of achalasia symptoms when laparoscopic surgery and endoscopic approach have not been effective. The present case shows the final resolution after a series of failures, through a laparoscopic cardiomyotomy procedure in which the surgical experience of the participating surgeons is an important factor for the success on cases after failed procedures.

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