Esophageal Induced Acute Airway Obstruction

Achalasia is a rare esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation, commonly presenting with dysphagia, chest discomfort, and regurgitation of undigested food. Significant esophageal dilation can lead to rare but serious acute airway obstruction.

We present the case of a 79-year-old female with known achalasia who presented to the emergency department with acute respiratory distress and biphasic stridor following a meal. Initial treatment for suspected anaphylaxis was ineffective, and the patient required emergent intubation. Imaging revealed a dilated esophagus with an air-fluid level exerting mass effect on the trachea. Following intubation, emergent nasogastric decompression and endoscopic esophagoscopy resolved the esophageal obstruction, enabling extubation on hospital day 2. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights a rare presentation of achalasia, where esophageal dilation caused acute airway obstruction and respiratory distress. Emergency physicians should recognize that esophageal obstruction can cause acute respiratory distress. The clinical findings of postprandial stridor and imaging findings of an air-fluid level on chest X-ray can aid in making the diagnosis. Interventions such as nasogastric decompression or upper endoscopy are critical to prevent severe complications and improve outcomes. Early recognition and treatment of esophageal-induced acute airway obstruction are crucial for timely intervention and improved patient outcomes.