A case of esophageal achalasia presenting with empyema and septic shock differentiated from esophageal rupture

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Abstract

The patient was a 44-year-old man with a history of schizophrenia. He had a history of esophageal dysphagia and vomiting and presented with sudden strong epigastric pain. He was taken to a medical emergency center in a state of septic shock. Computed tomography revealed a left thoracic abscess, and esophageal rupture was suspected. He was referred to our department for treatment. Gastrointestinal series and gastrointestinal endoscopy revealed marked esophageal dilation and strong contraction of the lower esophageal sphincter. We, therefore, diagnosed the patient with empyema thoracis secondary to aspiration pneumonia due to esophageal achalasia. Conservative treatment with antibiotics and computed tomography-guided chest drainage was initiated, but the inflammation persisted. Thus, we successfully performed a per-oral endoscopic myotomy to manage achalasia symptoms.

Original languageEnglish
Pages (from-to)422-426
Number of pages5
JournalClinical Journal of Gastroenterology
Volume14
Issue number2
DOIs
Publication statusPublished - 2021 Apr

Keywords

  • Achalasia
  • Empyema
  • Esophageal rupture
  • Per-oral endoscopic myotomy

ASJC Scopus subject areas

  • Gastroenterology

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