End-stage achalasia presenting as acute respiratory failure: a case report and review of the literature

Abstract

Background: Achalasia is a primary esophageal motility disorder, predominantly presenting with dysphagia. With disease progression, the esophagus becomes tortuous and dilated, resulting in a condition known as “megaesophagus.” Tracheal compression with acute respiratory failure due to esophageal dilation is a rare but potentially fatal complication of achalasia. Case report: A 52-year-old male patient presented with acute respiratory failure and a history of prior dysphagia, regurgitation, and pneumonia. Further diagnostic tests revealed an extremely dilated esophagus compressing the trachea and lung parenchyma. Results: Laparoscopic Heller myotomy and fundoplication were performed, which alleviated the patient’s symptoms. Conclusion: Early recognition of this condition is crucial for patient survival, as is initial decompression of the dilated esophagus, relieving the patient of acute, life-threating symptoms. © The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2025.