Khandelwal Meena, Krueger Chad
Department of Obstetrics & Gynecology, Cooper University Hospital, University of Medicine & Dentistry of New Jersey, 1 Cooper Plaza, 623 Dorrance Building, Camden, NJ 08103, USA.
ISRN Gastroenterol. 2011;2011:871958. doi: 10.5402/2011/871958. Epub 2010 Oct 18.
Background. The optimal treatment for management of esophageal achalasia in pregnancy is controversial. Little information exists about pregnancy outcome after successful myotomy. Case. Achalasia in pregnancy was diagnosed when a patient presented with pneumomediastinum from microrupture of the overdistended esophagus. An attempt at surgical correction failed due to the development of aspiration pneumonia with general anesthesia. Conservative medical therapy was undertaken, but fetal growth restriction developed. The patient underwent interval surgical correction, but subsequent pregnancy 6 months later was complicated by acute diaphragmatic hernia necessitating preterm delivery. Conclusion. Prior to surgery in pregnancy, emptying the dilated esophagus via nasoesophageal tube suctioning maybe warranted to avoid aspiration. Women, despite having undergone successful myotomy, should be counseled on the risks of pregnancy and to avoid pregnancy for at least 1 year thereafter.
背景。妊娠期食管贲门失弛缓症的最佳治疗方法存在争议。关于成功进行肌切开术后的妊娠结局，相关信息较少。病例。一名患者因过度扩张的食管微破裂导致纵隔气肿，被诊断为妊娠期贲门失弛缓症。由于全身麻醉后发生吸入性肺炎，手术矫正尝试失败。采取了保守药物治疗，但出现了胎儿生长受限。患者接受了间隔期手术矫正，但6个月后的再次妊娠并发急性膈疝，需要早产。结论。在妊娠期手术前，通过鼻食管管抽吸排空扩张的食管可能是必要的，以避免误吸。尽管已经成功进行了肌切开术，但仍应向女性咨询妊娠风险，并建议其在此后至少1年内避免妊娠。
