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Histology of the surgically-resected esophagus. (A) H&E staining showed the tumor invaded proper muscle layer (original magnification Â10), and (B) moderately differentiated squamous cell carcinoma with keratin pearl formation (original magnification Â200).
Source publication
Rationale:
Esophageal hemorrhage may occasionally develop subsequent to esophagitis and stasis ulcer, but potentially fatal esophageal bleeding is very uncommon in primary achalasia.
Patient concerns:
We describe a case of a 64-year-old man with long-standing achalasia and megaesophagus who presented acute episodes of life-threatening upper gast...
Context in source publication
Context 1
... esophagectomy was planned to treat the esophageal malignancy, and the patient underwent an Ivor-Lewis operation successfully. Histopathologic examination of the resected esophagus revealed moderately differentiated squamous cell carcinoma with keratin pearl formation that invaded the proper muscle layer (Fig. 4). The tumor was diagnosed as stage IIA (T2, N0, M0) according to the tumor node metastasis classification for esophageal cancer, [6] and was of histopathological grade G2 (moderately differentiated). The patient's postoperative course was uneventful, and he was discharged 10 days after surgery. He has since been followed up for 6 months ...
Citations
... Reflux esophagitis, as the most common secondary disorder of gastrointestinal motility after the esophageal cancer surgery, refers to the inflammatory lesions caused by the reflux of the contents in the stomach and duodenum into the esophagus [11]. According to the survey by scholar Liu Xiao-Long, 8.90% of the residents in Beijing and Shanghai have the symptom of gastroesophageal reflux in different degrees, and the actual probability of developing gastroesophageal reflux disease is 5.70%. ...
Objective:
To investigate the risk factors associated with reflux esophagitis in patients undergoing esophageal cancer surgery and to provide reference for the prevention and treatment of reflux esophagitis.
Methods:
In the manner retrospective study, the data of 300 patients with esophageal cancer who received the surgical treatment in our hospital (January 2018-December 2020) were retrospectively reviewed. The 300 patients were divided into the occurrence group (n = 45) and nonoccurrence group (n = 255) depending on whether they had reflux esophagitis after surgery. The social demographic data and clinical data of the patients in the two groups were collected. These data were classified into the personal factors and surgical factors. The single-factor analysis method was adopted to analyze the effects of the personal and surgical factors on reflux esophagitis. The factors with statistically significant differences in the single-factor analysis were analyzed by logistic regression to verify the factors were the risk factors associated with reflux esophagitis in patients undergoing esophageal cancer surgery.
Results:
The differences in the bodyweight, body mass index (BMI), length of the resected esophagus, surgical approach, intraoperative blood loss, gastrointestinal decompression volume, and surgery time between the two groups were of statistical significance (P < 0.05). After being tested by the logistics multivariate analysis, length of the resected esophagus, whole stomach reconstruction, intraoperative blood loss, and surgery time were identified as the risk factors associated with reflux esophagitis in patients undergoing esophageal cancer surgery.
Conclusion:
The length of the resected esophagus, whole stomach reconstruction, intraoperative blood loss, and surgery time were the risk factors associated with reflux esophagitis in patients undergoing esophageal cancer surgery. It is necessary to choose the appropriate surgical approach according to the patients' conditions in practice and to strengthen the prevention and treatment of reflux esophagitis.
... Achalasia is an idiopathic primary motor disorder characterized by esophageal aperistalsis and incomplete relaxation of the lower esophageal sphincter (LES) [1][2][3]. The underlying pathophysiology is attributed to a functional loss of the myenteric plexus of Auerbach, resulting in an impairment of the inhibitory postganglionic neurons in the distal esophagus and LES [4][5][6]. ...
... Achalasia is a relatively rare disorder with an incidence rate of 1 in 100,000 and a prevalence of 1 in 10,000 in the United States with an equal distribution in males and females [2,6]. Clinically, the diagnosis of achalasia is often delayed because of its similar presentation with other more prevalent diseases such as gastroesophageal reflux disease (GERD) [6][7]. ...
... Infrequently, sigmoid dolichomegaesopahagus can cause an acute airway obstruction from the regurgitation of food and present clinically as asthma, pneumonia, or a lung abscess requiring urgent treatment [4,11]. Furthermore, in extremely rare situations, long-standing primary achalasia can also result in fatal esophageal hemorrhage due to underlying mucosal irritation and ulcer formation [2,8,12]. To our knowledge, the etiology of upper gastrointestinal (GI) bleeds in achalasia were due to cytomegalovirus (CMV) esophagitis, esophageal varices, excessive ingestion of tannins, esophagopulmonary fistula, non-Hodgkin esophageal lymphoma, and excessive aspirin ingestion [2,[4][5][12][13]. ...
Achalasia is a relatively rare motor disorder characterized by esophageal aperistalsis and incomplete relaxation of the lower esophageal sphincter. In only 10% of patients, untreated or poorly managed achalasia can progress to esophageal dilation and eventual loss of total functionality resulting in a characteristic sigmoid dolichomegaesopahagus. In extremely rare instances, this sigmoid dolichomegaesopahagus can present clinically as acute airway obstruction or a fatal, life-threatening hemorrhage requiring immediate intervention. We present the case of a 65-year-old female with a past medical history of long-standing achalasia who had complaints of shortness of breath, chest pain, and two episodes of life-threatening hematemesis requiring a blood transfusion. An angiography illustrated significant distention of the esophagus occupying most of the right hemithorax and non-specific intraluminal fluid with a small amount of gas. Emergent esophagogastroduodenoscopy showed fibrosis and necrosis of the esophageal mucosa with food debris, suggesting that the bleeding was likely coming from an ulcer caused by pressure necrosis. The patient was hemodynamically unstable after the procedure and was transferred to another facility the next day for an esophagectomy. Patients with achalasia have an increased susceptibility to develop pressure ulcers due to increased shear force on the esophageal wall, increased moisture of the esophageal wall from prolonged contact of food boluses, and underlying malnutrition and weight loss from the indigestion of food causing atrophy of the mucosal barriers. The management of these ulcers is to treat and manage the underlying cause. Although there are no curative treatments for achalasia, symptomatic relief through both surgical and medical therapies are the mainstay of management, with an esophagectomy reserved for refractory cases or in patients who develop end-stage complications.
