[Dolichomegaesophagus in achalasia. Therapy by esophogectomy in an aged patient].
METHODS
A 78-year-old woman suffered from achalasia since 63 years with a progressive decompensation over the last year. 53 years ago, treatment with the Stark Dilator and 24 years ago, pneumatic dilation had been carried out. Currently, the patient presented with dysphagia for liquid and solid food, with permanent retrosternal pain and regurgitation for every meal, leading to a weight loss of 10 kg.


METHODS
The barium esophagogram showed a marked dilation of the esophagus with retinated secretions and food. The cardia had a maximum width of 15 mm. On endoscopy, reflux esophagitis and an insufficient lower esophageal sphincter were evident.


METHODS
Transhiatal esophageal resection with gastric pull-up and cervical esophagogastrostomy was performed. The postoperative course was without complications and normal alimentation could be restored with a marked improvement of preoperative symptoms.


CONCLUSIONS
Esophageal resection and gastric pull up is the more favourable treatment option in elderly patients with decompensated achalasia and dolichomegaesophagus compared to a gastric tube for alimentation--adjusted to the individual surgical risk.
Gockel
I
I
Klinik für Allgemein- und Abdominalchirurgie, Johannes Gutenberg-Universität, Mainz. gockel@ach.klinik.uni-mainz.de
Eckardt
V F
VF
Roth
W
W
Junginger
Th
T
D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004931:Esophageal Achalasia / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016629:Esophagectomy; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000209:etiology; D004943:Esophagogastric Junction / Q000503:physiopathology; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000601:surgery; D006801:Humans; D011859:Radiography; D015431:Weight Loss