Diaphragmatic Hernia after Laparoscopic Esophagomyotomy for Esophageal Achalasia in Pregnancy

Abstract

Background. The optimal treatment for management of esophageal achalasia in pregnancy is controversial. Little information exists about pregnancy outcome after successful myotomy. Case. Achalasia in pregnancy was diagnosed when a patient presented with pneumomediastinum from microrupture of the overdistended esophagus. An attempt at surgical correction failed due to the development of aspiration pneumonia with general anesthesia. Conservative medical therapy was undertaken, but fetal growth restriction developed. The patient underwent interval surgical correction, but subsequent pregnancy 6 months later was complicated by acute diaphragmatic hernia necessitating preterm delivery. Conclusion. Prior to surgery in pregnancy, emptying the dilated esophagus via nasoesophageal tube suctioning maybe warranted to avoid aspiration. Women, despite having undergone successful myotomy, should be counseled on the risks of pregnancy and to avoid pregnancy for at least 1 year thereafter.

Postoperative pregnancy in female achalasia patients: Report of three cases

“…Several studies reported that achalasia symptoms may be exacerbated with elevation of the diaphragm by the fetus during pregnancy [ 13 , 14 ]. Additionally, increasing the concentration of progesterone during pregnancy can lead to a decrease in smooth muscle motility and tension, gastric acid reflux into the esophagus can cause esophagitis [ 15 ]. In our series, pregnancy caused relapse of the same preoperative symptoms in all 3 patients, even though the symptoms improved after surgery.…”

En gravid kvinne med oppkast og pustebesvær

“…Samme rapport Risikoen ved nye svangerskap belyses av en kvinne med gjennomgått myotomi som i påfølgende svangerskap ble innlagt med svaer mediastinal herniering av ventrikkel/ tarm. Et slikt brokk kan gi akutt dyspné ved kompresjon og akuttkirurgi kan bli nødvendig, uavhengig av svangerskapsalder (22).…”