Two-Stage Esophagectomy for End-Stage Achalasia with Low Cardiac Function and Severe Malnutrition

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  • 低心機能および重症低栄養を伴う末期アカラシアに対して2期分割食道切除再建術を施行した症例

Abstract

<p>A 75-year-old woman was referred to our hospital with a primary complaint of dysphagia and was diagnosed with esophageal achalasia. She suffered from perforation of the esophagus after balloon dilatation; however, she was discharged after the symptoms improved. After 1 year and 6 months, she returned to our hospital following a flare-up of symptoms. CT and oral contrast examination revealed a dilated S-shaped deformed esophagus with a maximum diameter of 7.5 cm. Because esophageal perforation occurred during the initial dilatation, further dilatation could not be performed, and there was a high risk of perforation during myotomy or peroral endoscopic myotomy; therefore, an esophagectomy was performed. As the patient had malnutrition and low cardiopulmonary function, one-stage esophagectomy and reconstruction had a high risk of perioperative complications, and hence a two-stage divided surgery was used. The patient had a good postoperative course and was discharged on the 31st postoperative day. Following discharge, her food intake increased, and at 1 month after discharge, she was able to consume approximately 1,300–1,400 kcal/day orally. An esophagectomy is highly invasive and is rarely performed for patients with esophageal achalasia, but our case suggests that it should be considered depending on the examination findings and treatment course.</p>

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