End-stage achalasia presenting as acute respiratory failure: a case report and review of the literature

Achalasia is a primary esophageal motility disorder, predominantly presenting with dysphagia. With disease progression, the esophagus becomes tortuous and dilated, resulting in a condition known as “megaesophagus.” Tracheal compression with acute respiratory failure due to esophageal dilation is a rare but potentially fatal complication of achalasia.

A 52-year-old male patient presented with acute respiratory failure and a history of prior dysphagia, regurgitation, and pneumonia. Further diagnostic tests revealed an extremely dilated esophagus compressing the trachea and lung parenchyma.

Laparoscopic Heller myotomy and fundoplication were performed, which alleviated the patient’s symptoms.

Early recognition of this condition is crucial for patient survival, as is initial decompression of the dilated esophagus, relieving the patient of acute, life-threating symptoms.