Vivian F Lu, Dahiya Dushyant S, Shea Connor B, Tuma Faiz
General Surgery, Central Michigan University College of Medicine, Saginaw, USA.
Internal Medicine, Central Michigan University College of Medicine, Saginaw, USA.
Cureus. 2022 Jan 26;14(1):e21639. doi: 10.7759/cureus.21639. eCollection 2022 Jan.
The surgical management of achalasia with sigmoid esophagus involves multiple significant challenges due to the difficulty in endoscopic assessment, esophageal motility disorders, and potential complication and recurrence rates. We report a 34-year-old female with worsening dysphagia and malnourishment due to advanced achalasia. An esophagogastroduodenoscopy (EGD) revealed an esophageal dilation, tortuosity, and distal blockage with undigested food. Esophagram demonstrated the typical bird beak appearance with a tortuous dilated esophagus. She underwent a laparoscopic Heller myotomy with Dor fundoplication with no complications. She was discharged on the second postoperative day, tolerating clear liquids, and then a normal diet within six weeks. Several treatment options exist for the surgical management of a sigmoid esophagus with achalasia, but there is no clear gold standard. In our case, Heller myotomy with Dor fundoplication provided favorable results, but treatment should be individualized for each case.
由于内镜评估困难、食管动力障碍以及潜在的并发症和复发率，乙状结肠型食管贲门失弛缓症的外科治疗面临多个重大挑战。我们报告一名34岁女性，因晚期贲门失弛缓症导致吞咽困难和营养不良加重。食管胃十二指肠镜检查（EGD）显示食管扩张、迂曲，远端有未消化食物堵塞。食管造影显示典型的鸟嘴样外观，食管迂曲扩张。她接受了腹腔镜下Heller肌切开术加Dor胃底折叠术，无并发症。术后第二天出院，能耐受清流食，六周内恢复正常饮食。对于乙状结肠型食管贲门失弛缓症的外科治疗有多种选择，但尚无明确的金标准。在我们的病例中，Heller肌切开术加Dor胃底折叠术取得了良好效果，但治疗应根据每个病例个体化。
