Abstract
BackgroundEsophageal achalasia is a rare disease with a high risk of aspiration during anesthesia induction. Here, we describe our experience involving a case of undiagnosed esophageal achalasia with profuse vomiting during anesthesia induction.Case presentationA 58-year-old woman was scheduled for orthopedic surgery under general anesthesia. She vomited a large amount of watery contents during anesthesia induction, and planned surgery was postponed. After recovery from anesthesia, she informed us that she usually had to drink a large amount of water to get food into her stomach and purged watery vomit every night before sleep. However, she attributed it to her constitutional problem, not to a specific disease. She was subsequently diagnosed with esophageal achalasia and underwent Heller myotomy with Dor fundoplication before her re-scheduled orthopedic surgery.ConclusionsA detailed history of dysphagia and regurgitation should be taken in preoperative examinations to prevent unexpected aspiration due to undiagnosed achalasia.
Highlights
BackgroundEsophageal achalasia is a rare disease (incidence, 1 in 100,000) associated with a high risk of aspiration during the induction of general anesthesia due to difficulties in passing food [1]
Esophageal achalasia is a rare disease with a high risk of aspiration during anesthesia induction
A detailed history of dysphagia and regurgitation should be taken in preoperative examinations to prevent unexpected aspiration due to undiagnosed achalasia
Summary
Esophageal achalasia is a rare disease (incidence, 1 in 100,000) associated with a high risk of aspiration during the induction of general anesthesia due to difficulties in passing food [1]. After returning to the ward, a more detailed medical history was obtained from the patient She said that she usually had to drink a large amount of water to get food into her stomach. She made it a daily habit to purge watery vomit before bed, as it would reflux when she lay down She had an upper gastrointestinal endoscopy a few years prior, the physician had not pointed out anything unusual. Esophageal manometry showed the disappearance of primary peristaltic waves and the occurrence of simultaneous contraction waves Based on these results, the patient was diagnosed with esophageal achalasia and underwent laparoscopic Heller myotomy with Dor fundoplication surgery. The patient was diagnosed with esophageal achalasia and underwent laparoscopic Heller myotomy with Dor fundoplication surgery After the surgery, her subjective symptoms, including choking with food and daily vomiting before bed, disappeared. She underwent posterior interbody fusion of the lumbar spine without any anesthetic complications
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