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Saudi Journal of Medical and Pharmaceutical Sciences (SJMPS)
Volume-9 | Issue-07 | 413-418
Case Report
Achalasia: Case Report and Literature Review
Fadi Bassam Almahameed, Ashraf ALakkad, Mohammad Saeed Sarwar, Mohammad Eid Ali, Ashraf Saad Meligy, Sowjanya Kalidindi
Published : July 6, 2023
DOI : DOI: 10.36348/sjmps.2023.v09i07.006
Abstract
Background: Achalasia is a medical ailment characterized by irregular contractions of the esophagus and incomplete relaxation of the lower esophageal sphincter. This condition results in difficulty swallowing food and liquids, and often leads to regurgitation and heartburn. Case presentation: This case report describes a 36-year-old female patient who presented with difficulty swallowing, heartburn, chest pain, and coughing while eating or drinking. The patient had lost significant weight despite a good appetite, and a physical examination revealed poor nutrition. Esophageal manometry confirmed the diagnosis of Achalasia Type 1, and endoscopy showed severe Candida esophagitis and a very dilated esophagus with diverticula. Due to the patient's condition and endoscopic finding of diverticula, surgery was considered, as she did not qualify for the Peroral Endoscopic Myomectomy (POEM) procedure. The patient was treated with fluconazole to address the esophageal candidiasis, and NG feeding was initiated to improve weight and nutrition. After recovering, the patient underwent a laparoscopic Heller myotomy with Dor fundoplication using a video laryngoscope to facilitate intubation. Anesthesia was maintained with O2/air with Sevoflurane, and the patient was extubated and transferred to the post-anesthesia care unit. Conclusion: Achalasia is a frequently researched esophageal motility disorder that is distinguished by inadequate relaxation of the LES and absent or irregular peristalsis in the esophagus. Common symptoms in most patients include difficulty swallowing solids and liquids, regurgitation, and varying degrees of weight loss. This case highlights the importance of prompt diagnosis and treatment of Achalasia Type 1, as well as the use of rapid sequence induction and proper anesthesia techniques during surgery.
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