Achalasia in a 15-year-old child with recurrent respiratory infections: a case report

Achalasia is a rare childhood disease. We report a case of a 15-year-old child with recurrent respiratory infections over the past 5 years. Due to positive household contacts with relatives with positive sputum pulmonary tuberculosis, he was referred to our pulmonology clinic. The child exhibited symptoms of failure to thrive, fatigue, intermittent fever, and chronic dry cough. A detailed medical history revealed that the child vomited almost after every meal and had regurgitation and odynophagia. On physical examination, the child was in a poor general condition, with an intoxicated appearance, febrile (38.5°C), with asthenic habitus, and with evidence of respiratory failure. The chest X-ray shows a strongly enlarged paratracheal shadow and infiltrative changes in the left lower lung lobe, which indicated various conditions affecting the trachea, mediastinum, or pleura. A CT scan of the lungs revealed severe long-term esophageal achalasia with an extremely dilated lumen measuring 69×58 mm in axial size. The bird’s beak sign in the esophagus was seen on a barium swallow. An esophagoscopy was performed in a surgery clinic, during which a large amount of food material was removed. Three dilations of the esophagus were performed, followed by a one-month period of nutritional support. A laparoscopic Heller myotomy was performed, followed by four balloon dilations of the cardia under endoscopic control using pneumatic and hydrostatic dilators over a period of one year with significant clinical improvement.