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.

Figure 1

A: Barium esophagography and upper gastrointestinal series showing an intact gastroesophageal junction; B: dilated distal esophageal lumen with food retention and narrowing of gastroesophageal junction after truncal vagotomy; C: barium esophagography showing a non-dilated esophageal lumen with smooth passage of contrast medium through gastroesophageal junction after pneumodilations.

Figure 2

Confirmation of achalasia by manometric findings of esophageal aperistalsis and incomplete relaxation of the lower esophageal sphincter during wet swallowing.

Figure 3

Manomteric studies showing restoration of esophageal motility with normal peristalsis as a healthy subject after dilations.