Massive Food Impaction in Achalasia

We report a cases of acute dysphagia in the context of massivefood impaction. The patient was, a 23-year-old woman, presented with a late complication of achalasia. Impaction was the first manifestation of this disease. In the patient, upper endoscopy revealed a dilated esophagus with food occupying its nearly entire lumen, with no identifiable strictures or masses. Subsequent esophageal manometry confirmed the diagnosis of type II achalasia. She then underwent a laparoscopic Heller`s cardiomyotomy with Dor fundoplication. Achalasia is a rare condition characterized by an ineffective relaxation of the lower esophageal sphincter associated with absence of peristaltic contractions of the esophagus body. Most patients present with dysphagia for solids and liquids which progresses slowly over months to years, often accompanied by regurgitation, weight loss and sometimes chest pain. Cases of food impaction in the context of achalasia are rare, probably due to the diet modifications that patients adopt over time. As a landmark of long-term achalasia, marked dilation of the esophagus can store massive amounts of food that limit the endoscopic intervention in case of impaction, as in the described case.