Title : Laparoscopic heller myotomy with anterior fundoplication in an elderly male patient with achalasia and coexisting miliary tuberculosis: A case report
Abstract:
Background: This case report aims to present the applicability and safety of laparoscopic Heller myotomy with anterior fundoplication in an elderly male patient with achalasia and coexisting military tuberculosis. Although the exact cause of achalasia has not been determined, the clinical course of the patient’s pulmonary tuberculosis and the occurrence of achalasia suggests a possible association between these two diseases. Further studies are needed to confirm this association, as military tuberculosis has been reported to invade the esophagus in published journal articles. Pathogenesis includes micro-invasion of the organism in the esophageal myenteric plexus or the paraneoplastic effects of the inflammation.
Case Presentation, Methods, and Results: A 70-year-old, male patient presented with decreased appetite, episodes of vomiting, and generalized body weakness a few weeks prior to admission. He was previously diagnosed with pulmonary tuberculosis several years prior and underwent treatment. He had also been diagnosed with achalasia in 2022. Upon admission, he underwent esophagogastroduodenoscopy which showed achalasia and a markedly dilated esophagus, tight gastroesophageal junction but still able to pass scope through. A chest CT scan with intravenous contrast was also performed, showing miliary tuberculosis and megaesophagus. He later underwent surgery for achalasia, laparoscopic Heller myotomy with anterior fundoplication, perigastric lymph node biopsy. The intraoperative course was uneventful, and he was subsequently started on NGT feeding and progressed to regular diet. Nifedipine and anti-TB medications were also resumed. Histopathological examination of the perigastric lymph node showed chronic granulomatous lymphadenitis with Langhans giant cells, presumptive of tuberculous etiology. He was discharged improved on the 10th post-operative day.
Conclusion: Laparoscopic Heller Myotomy with Anterior Fundoplication was a safe and doable surgical treatment in our elderly, male patient with achalasia and co-existing miliary tuberculosis.
