尼氏胃底折叠术20年后出现的假性贲门失弛缓症：一例报告
Pseudoachalasia presenting 20 years after Nissen fundoplication: a case report.
作者信息
Lai Chuong N, Krishnan Kumar, Kim Min P, Dunkin Brian J, Gaur Puja
机构信息
Department of Medicine, Texas A&M University, College Station, TX, USA.
Department of Gastroenterology, Houston Methodist Hospital, Houston, TX, USA.
出版信息
J Cardiothorac Surg. 2016 Jul 7;11(1):96. doi: 10.1186/s13019-016-0495-y.
BACKGROUND
Pseudoachalasia is a rare diagnosis manifested by clinical and physiologic symptoms of achalasia, with alternative etiology for outflow obstruction. While malignancy is a frequent cause of pseudoachalasia, prior surgical intervention especially surgery involving the esophagogastric junction, may result in a misdiagnosis of achalasia.
CASE PRESENTATION
We present a case of a 70 year-old male with dysphagia and weight loss after undergoing a Billroth I and Nissen fundoplication several decades ago. His preoperative studies suggested achalasia and he was therefore referred for an endoscopic myotomy. However, careful interpretation of all the data and intra-operative findings revealed a classic mechanical and functional obstruction requiring takedown of his prior wrap.
CONCLUSIONS
Individualized interpretation of preoperative studies in the setting of prior foregut surgery is critical to appropriate diagnosis and intervention. This case highlights the significance of endoscopic findings and features of high-resolution manometry specific to pseudoachalasia, which contrasts with classical features of achalasia.
背景
假性贲门失弛缓症是一种罕见的诊断，表现为贲门失弛缓症的临床和生理症状，存在流出道梗阻的其他病因。虽然恶性肿瘤是假性贲门失弛缓症的常见病因，但既往手术干预，尤其是涉及食管胃交界部的手术，可能导致贲门失弛缓症的误诊。
病例介绍
我们报告一例70岁男性病例，该患者在几十年前接受毕罗一式手术和nissen胃底折叠术后出现吞咽困难和体重减轻。他的术前检查提示贲门失弛缓症，因此被转诊接受内镜下肌切开术。然而，对所有数据和术中发现的仔细解读显示存在典型的机械性和功能性梗阻，需要拆除他之前的胃底折叠术。
结论
在既往前肠手术的情况下，对术前检查进行个体化解读对于正确诊断和干预至关重要。本病例突出了内镜检查结果以及假性贲门失弛缓症特有的高分辨率测压特征的重要性，这与贲门失弛缓症的经典特征形成对比。
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