Sigmoid megaesophagus as clinical presentation of achalasia

The patient is a 68-year-old woman, originally from Peru, with a history of dysphagia for many years. She consulted in the emergency room for oppressive postprandial mid-thoracic pain associated with dyspnea, dysphagia and vomiting, reporting similar episodes in the previous months.

Chest radiograph showed an enlarged mediastinum, and the CT scan revealed severe esophageal dilation (Fig. 1).

Fig. 1

Fibrogastroscopy identified a dilated esophagus with abundant food content, ruling out obstructive causes. Serology was negative for Chagas disease.

Esophageal manometry was consistent with stage IV achalasia.