General Surgery, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
General Surgery, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
BMJ Case Rep. 2021 Sep 21;14(9):e243229. doi: 10.1136/bcr-2021-243229.
Achalasia is a rare cause of neck swelling. We report the case of a 75-year-old woman, who presented with an intermittent, unilateral neck swelling, associated with dysphagia, weight loss and regurgitation. The patient underwent a gastroscopy and barium swallow. This confirmed a dilated oesophagus with poor motility and hold up of liquid and food residue above the gastro-oesophageal junction, thus revealing the swelling was secondary to severe achalasia. The patient was managed with botulinum toxin injections and pneumatic dilatations but the results were short lived. She is now having manometry and is being considered for a Heller myotomy or peroral oesophageal myotomy. Delayed diagnosis and treatment of achalasia can result in the development of a neck swelling, which could later cause airway compromise and subsequent mortality. Achalasia should therefore be considered in patients with an initial diagnosis of gastro-oesophageal reflux disease who do not respond to proton pump inhibitors.
贲门失弛缓症是一种罕见的颈部肿胀病因。我们报告了一例 75 岁女性患者，其表现为间歇性单侧颈部肿胀，伴有吞咽困难、体重减轻和反流。患者接受了胃镜和钡餐检查。这证实了食管扩张，运动不良，胃食管交界处上方液体和食物残渣滞留，从而表明肿胀是严重贲门失弛缓症的结果。患者接受了肉毒杆菌毒素注射和气动扩张治疗，但效果短暂。她现在正在进行测压检查，并考虑进行 Heller 肌切开术或经口食管肌切开术。贲门失弛缓症的延迟诊断和治疗可导致颈部肿胀的发展，进而导致气道阻塞和随后的死亡。因此，对于最初诊断为胃食管反流病但质子泵抑制剂治疗无效的患者，应考虑贲门失弛缓症。
