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Intermittent neck swelling: an unusual presentation of achalasia cardia
  1. Piriyanga Kesavan,
  2. Shivani Joshi and
  3. Yüksel Gercek
  1. General Surgery, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
  1. Correspondence to Dr Piriyanga Kesavan; piriyanga.kesavan1{at}nhs.net

Abstract

Achalasia is a rare cause of neck swelling. We report the case of a 75-year-old woman, who presented with an intermittent, unilateral neck swelling, associated with dysphagia, weight loss and regurgitation. The patient underwent a gastroscopy and barium swallow. This confirmed a dilated oesophagus with poor motility and hold up of liquid and food residue above the gastro-oesophageal junction, thus revealing the swelling was secondary to severe achalasia. The patient was managed with botulinum toxin injections and pneumatic dilatations but the results were short lived. She is now having manometry and is being considered for a Heller myotomy or peroral oesophageal myotomy. Delayed diagnosis and treatment of achalasia can result in the development of a neck swelling, which could later cause airway compromise and subsequent mortality. Achalasia should therefore be considered in patients with an initial diagnosis of gastro-oesophageal reflux disease who do not respond to proton pump inhibitors.

  • botulinum toxin
  • endoscopy
  • oesophagus
  • gastro-oesophageal reflux
  • gastrointestinal surgery

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Footnotes

  • Contributors PK wrote the case report. SJ contributed in further editing, and the literature review. YG was the supervising consultant and also contributed to further editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.