Esophageal Induced Acute Airway Obstruction

Area of Science:

• Gastroenterology
• Emergency Medicine
• Pulmonology

Background:

• Achalasia is a rare esophageal motility disorder affecting lower esophageal sphincter relaxation.
• Common symptoms include dysphagia, chest discomfort, and regurgitation.
• Severe esophageal dilation in achalasia can rarely cause acute airway obstruction.

Purpose of the Study:

• To present a case of achalasia causing acute airway obstruction.
• To emphasize the importance of emergency physician awareness of this rare presentation.
• To highlight diagnostic clues and critical interventions.

Main Methods:

• Case report of a 79-year-old female with known achalasia presenting with acute respiratory distress.
• Initial management included intubation due to suspected anaphylaxis.
• Diagnosis confirmed by imaging showing esophageal mass effect on the trachea.

Main Results:

• Emergent nasogastric decompression and endoscopic esophagoscopy resolved the obstruction.
• The patient was successfully extubated on hospital day 2.
• This intervention prevented severe complications and improved outcomes.

Conclusions:

• Esophageal obstruction from achalasia can mimic other conditions causing acute respiratory distress.
• Emergency physicians must consider esophageal obstruction in patients with postprandial stridor and relevant imaging findings.
• Timely recognition and interventions like nasogastric decompression are crucial for managing this rare but serious complication.