Achalasia of the Esophagus at Donka National Hospital: A Case Report

Background: Esophageal achalasia is an esophageal motility disorder of unknown etiology that results in impaired lower esophageal sphincter relaxation and loss of esophageal peristalsis. The aim of our study was to show our experience in the management of esophageal achalasia in a case treated by laparotomy in our service. Case Report: 21-year-old patient, student, admitted to our department for progressive dysphagia to solids accompanied by regurgitation, epigastric pain, nocturnal cough and weight loss, evolving for 5 years. ATCD of pulmonary tuberculosis. The physical examination noted a deterioration in general condition, stage (I) of the WHO; there was hypo coloration of the integuments and conjunctivae, TA=120/80mmHg, Pulse=70/min. The abdomen was symmetrical with presence of sluggish skin folds, supple and painless without a palpable mass, the digital rectal examination did not present any particularity. The thorax was symmetrical with a FR=20 c/mn. The biology showed a normo chrome and normocytic anemia of 8 g/l Group O+. The esogastroduodenal transit was in favor of an amputation (tight stenosis) extended on the cardia with megaesophagus upstream. We performed a cardiomyotomy according to Heller associated with a hemivalve according to Toupet. We performed a followed by preesophageal and subhepatic drainage. The postoperative course was simple, marked by a resumption of food on D6 postoperatively. The control test carried out with gastrographine 10 days after the surgical intervention noted a regression of the signs with passage of the product of contrast in the small intestine. The patient seen again 6 months after the operation showed no particularities. Conclusion: Achalasia is a chronic esophageal motility disorder characterized by the inability of the lower esophageal sphincter to relax. Heller cardiomyotomy by laparotomy associated with Toupet-type fundoplication retains its place in its management in our exercise context.