title: Unusual case of respiratory embarrassment secondary to tracheal compression by a dilated oesophagus in a patient with recurrent achalasia.
abstract: We present the case of a 79-year-old woman with recurrent achalasia following a laparoscopic Heller's cardiomyotomy. The patient presented to the emergency department, with epigastric pain, severe dyspnoea and profound respiratory acidosis. She required intubation and ventilation followed by gastric decompression with nasogastric tube and the administration of intravenous antibiotics for a lower respiratory tract infection. Once stable, she underwent a CT scan revealing a massively dilated oesophagus causing marked tracheal compression. She received a period of continuous positive airway pressure ventilation while on the intensive care unit, for persistent low saturations, however, this was promptly ceased due to exacerbation of gastric dilation and fears over perforation. The patient responded well to conservative measures and was discharged home 18 days later awaiting follow-up with operating consultant surgeon.
authors.affiliation: Department of Urology, Lister Hospital, Stevenage, Hertfordshire, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brodie
authors.affiliation: Department of General Surgery, Lister Hospital, Stevenage, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Okeahialam
authors.affiliation: Department of General Surgery, Lister Hospital, Stevenage, UK.
authors.forename: Eriberto
authors.initials: E
authors.lastname: Farinella
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019468:Disease Management; D004931:Esophageal Achalasia / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D014132:Trachea / Q000293:injuries*
chemical_list: D000900:Anti-Bacterial Agents