The Suffocating Swallow – Acute Respiratory Failure Secondary to End Stage Achalasia

Dysphagia, regurgitation, chest pain and weight loss are classic presenting symptoms of achalasia. Acute respiratory failure, although reported in the medical literature, is an extremely rare presentation of achalasia. We herein present a rare case of airway compression secondary to end stage achalasia.

An 87-year-old female presented to the emergency department with acute postprandial dyspnea. Her O2 saturation on room air was 87%. Chest CT demonstrated a severely dilated esophagus with a large amount of food impaction up to the upper esophageal sphincter. Tracheal compression was also noted with probable aspiration pneumonia. After placement of an esophageal over-tube, an urgent gastroscopy was performed and a large amount of retained food removed from the esophagus using an endoscopic net. A spastic and tight lower esophageal sphincter was noted. Therefore, It was decided to perform botulinum toxin injection at the LES. The patient was indefinitely placed on a liquid diet with subsequent clinical improvement with no further respiratory complaintsThis case represents a serious and rare presentation of end stage achalasia, with compression of the trachea by a massively dilated esophagus resulting in acute respiratory failure that required urgent identification and endoscopic treatment by esophageal decompression. Due to the high-risk patient profile, and limited acute therapeutic options, Botox injection was performed with subsequent clinical improvement

Publication History

Article published online:
27 March 2025