Authors: Mihir S. Wagh, MD; Daniel S. Matloff, MD; David L. Carr-Locke, MD, FRCPSeries Editor: David L. Carr-Locke, MD, FRCP


September 21, 2004

Abstract and Introduction

Acute airway obstruction from mega-esophagus is an extremely rare presentation of achalasia. We present the case of an 82-year-old woman without previously diagnosed achalasia who presented with shortness of breath. Her respiratory status deteriorated rapidly, with development of stridor. Prompt nasogastric tube placement decompressed the dilated esophagus and relieved airway obstruction. This case illustrates an unusual presentation of achalasia and underscores the need for emergent life-saving esophageal decompression. Hypotheses regarding the mechanism of airway compromise as well as treatment options are reviewed.

Achalasia is an idiopathic motility disorder of the esophagus, characterized by aperistalsis of the esophageal body and nonrelaxation of the lower esophageal sphincter.[1] Acute airway compromise is a rare presentation of mega-esophagus from achalasia,[2,3,4] and respiratory decompensation can occur in minutes. We present a case of acute airway obstruction from a massively dilated esophagus in an elderly woman with no prior diagnosis of achalasia. Immediate decompression with a nasogastric tube offered prompt relief of symptoms. The purpose of this report is to highlight this rare complication and emphasize the need for emergent decompression of the esophagus, which can avoid fatality.