title: Esophageal perforation post pneumatic dilatation for achalasia managed by esophageal stenting.
abstract: METHODS
  Female, 82 FINAL DIAGNOSIS: Achalasia Symptoms: Nocturnal regurgtation • weight loss
  
  
  METHODS
  - Clinical Procedure: Esophageal stenting Specialty: Gastroenterology • Hepatology Objective: Unusual or unexpected effect of treatment.
  
  
  BACKGROUND
  Pneumatic dilatation is one of the most effective methods for treating achalasia. Esophageal perforation is the most serious complication after pneumatic dilatation and has been reported to occur in the range of 1 to 4.3%. The appropriate management of esophageal perforation can range from conservative medical treatment to surgical intervention.
  
  
  METHODS
  We report a case of an 82-year-old male who had an 8 month history of dysphagia for solid and liquids, a 10 lb weight loss and nocturnal regurgitation. The diagnosis of achalasia was established by endoscopic; barium and manometric criteria. He underwent a pneumatic dilation with a 30 mm Rigiflex balloon. A confined or limited esophageal perforation projecting into the mediastinum and located 1-2 cm above the diaphragm was confirmed by a gastrografin swallow study performed immediately after the procedure. There was some accompanying epigastric abdominal pain. PATIENT was treated later that day by placing a fully covered metallic esophageal stent in addition to antibiotics, proton pump inhibitor, and fasting. PATIENT was discharged home 3 days later able to eat liquid-soft foods. Follow up endoscopy 2 weeks later and a gastrografin swallow showed a completely healed perforation and the stent was removed. Symptomatically he has done well, with no dysphagia or heartburn at six and twelve months follow up.
  
  
  CONCLUSIONS
  Early esophageal stenting for esophageal perforation after pneumatic dilation for achalasia is a treatment option which accelerates healing shortens recovery period, as well as decreasing hospital stay and costs.
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Sherif
authors.initials: S
authors.lastname: Elhanafi
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Othman
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sunny
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Sarmad
authors.initials: S
authors.lastname: Said
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Cooper
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Haider
authors.initials: H
authors.lastname: Alkhateeb
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Raphael
authors.initials: R
authors.lastname: Quansah
authors.affiliation: Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, U.S.A.
authors.forename: Richard
authors.initials: R
authors.lastname: McCallum
keywords: esophageal achalasia; esophageal perforation; esophageal stenting; pneumatic dilation