[Achalasia caused by infiltrating carcinoma of the esophagus. Clinical case and physiopathological considerations].

A case of symptomatic esophageal achalasia due to a slowly growing neoplastic infiltration of the esophageal wall by a mammary indifferentiated carcinoma operated ten years before is presented. At admission, the clinical history and the endoscopic appearance of the esophageal lumen and mucosa led to the diagnosis of idiopathic achalasia, while the esophageal manometry showed a rather long high pressure zone (6--8 cm), which did not relax with deglutition. Barium study confirmed the length of the achalasic tract. Only thoracotomy permitted a correct diagnosis. On the basis of this case achalasia is thus considered as a syndrome which can be either idiopathic or secondary to Trypanosoma cruzi, high troncular vagotomy, benign or malignant tumor infiltrating the esophageal wall. The difficult diagnosis of some cases from the clinical point of view is underlined. Stress is laid on the necessity that all findings (history, radiology, endoscopy, manometry) be carefully evaluated to reach a preoperative diagnosis.