Pseudoachalasia in a patient after truncal vagotomy surgery successfully treated by subsequent pneumatic dilations

Abstract

Pseudoachalasia is a difficult condition for the clinician to differentiate from idiopathic achalasia even by manometry, radiological studies or endoscopy. Its etiology is usually associated with tumors. In most cases, the diagnosis is made after surgical explorations. The proposed pathogenesis of the disease is considered as mechanical obstruction of the distal esophagus or infiltration of the malignancy that affects the inhibitory neurons of the meyenteric plexus in the majority of cases. Surgery has been reported as a cause of pseudoachalasia. We report a 70-year-old man who suffered from deglutination disorder caused by pseudo-achalasia after truncal vagotomy. The patient was symptom-free after a nine-year follow-up and complete recovery of esophageal motility status from pseudoachalasia after pneumatic dilations. We also reviewed the literature of pseudoachalasia.

Clinical Remission in Endoscope-Guided Pneumatic Dilation for the Treatment of Esophageal Achalasia: 7-Year Follow-up Results of a Prospective Investigation

“…10 For many decades, many reports were published about long-term efficacy of the use of a 3-to 3.5-cm-diameter Rigiflex balloon to perform PD under the guidance of fluoroscope for patients with achalasia. 5 This procedure may be lost among the current generation of gastroenterologists due to many factors and are based on a misplaced fear of the risk of perforation, decreased immediate morbidity from laparoscopic myotomy compared to an open procedure, and some level of inconvenience to the already overly busy clinician.…”

The role of barium esophagogram measurements in assessing achalasia patients after endoscope-guided pneumatic dilation

“…Pneumatic dilation (PD) is considered to be one of the treatment options for achalasia but needs to exclude pseudoachalasia 1,2 . PD is accepted as a safe, effective, and relatively inexpensive option for achalasia treatment with fluoroscopy 3,4 .…”

An Involuntary and Unexpected Treatment of Nutcracker Esophagus

“…Normal pressure into inferior esophageal sphincter, presence of hypertensive peristalsis with mean distal contractile integral greater than 5,000 mm Hg/s/cm, and no swallow distal contractile integral greater than 8000 mm Hg/s/cm. e546 CASE REPORT healthy esophagus after bilateral truncal vagotomy has been reported [7]. Unilateral or bilateral lesions of the vagus nerve caused by extensive mediastinal lymph node dissection during lung cancer operations have also been suspected as being responsible for alteration of gastroesophageal motility [8].…”