Esophageal Perforation Following Pneumatic Dilation in Esophageal Achalasia Successfully Managed with Two-Stage Laparoscopic Surgery

Abstract

INTRODUCTION: Endoscopic treatment frequently results in minimal gastrointestinal content leakage and mild symptoms. However, surgical intervention may become necessary when the patient’s general condition is unstable. Further management of the underlying disease is required in cases where esophageal perforation occurs during endoscopic treatment. This report presents a case of esophageal perforation that occurred during the treatment of achalasia, underscoring the success of a two-stage laparoscopic approach.

CASE PRESENTATION: A 72-year-old male with a history of esophageal achalasia underwent treatment. Abdominal pain developed during pneumatic dilation. As the pain intensified, imaging studies revealed esophageal perforation. On admission, his vital signs were consistent with shock, and he was diagnosed with localized esophageal rupture. A two-stage laparoscopic surgery was performed, starting with closure of the 3.5-cm perforation and the creation of a jejunostomy for nutrition. Before the second surgery, the patient received a 10-day enteral nutrition and a laparoscopic Heller–Dor procedure, which was successfully completed without complications. On hospital day 22, the patient was discharged following a stable recovery without perioperative complications.

CONCLUSIONS: This case emphasizes the successful management of esophageal perforation following achalasia treatment through a minimally invasive surgery. The patient underwent curative surgery for esophageal achalasia during a short hospital stay.