Žugić, Anja (59546362200)Anja (59546362200)ŽugićSkrobić, Ognjan M. (16234762800)Ognjan M. (16234762800)SkrobićIvanović, Nenad (55375283100)Nenad (55375283100)IvanovićRašić, Slobodan (58920810100)Slobodan (58920810100)RašićJovanović, Sanja (57194155480)Sanja (57194155480)JovanovićJanković, Jelena (57211575577)Jelena (57211575577)JankovićĐurić-Stefanović, Aleksandra (59159742800)Aleksandra (59159742800)Đurić-StefanovićSimić, Aleksandar P. (7003795237)Aleksandar P. (7003795237)Simić2025-06-122025-06-122025https://doi.org/10.1007/s10353-024-00854-xhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-105001090603&doi=10.1007%2fs10353-024-00854-x&partnerID=40&md5=06223987ddd4e1b0c4d85680a95fede0https://remedy.med.bg.ac.rs/handle/123456789/510Background: 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.Esophageal motility disorderMegaesophagusPulmonary complicationsSurgical managementTracheal compression