A Rare Case of Advanced Achalasia with Recurrent Complications: A Multidisciplinary Approach to Management

Achalasia is a rare esophageal motility disorder characterized by dysphagia, regurgitation, and chest pain. These symptoms can significantly impair health, potentially leading to complications such as aspiration pneumonia and lung atelectasis, particularly in advanced disease stages. This report presents the case of a 54-year-old woman with advanced achalasia (Chicago classification 4.0), complicated by aspiration pneumonia, atelectasis, and comorbid rheumatoid arthritis. Initial management involved robot-assisted esophagofundostomy with Dor fundoplication to alleviate symptoms and restore esophageal function. Due to persistent complications, the patient subsequently required thoracolaparoscopic McKeown esophagectomy with microjejunostomy. Postoperative care emphasized multidisciplinary management of laryngeal paresis and respiratory distress through collaboration among thoracic surgeons, gastroenterologists, and respiratory therapists. While initial surgical intervention provided partial symptom relief, subsequent procedures were necessary to address recurrent complications. The definitive esophagectomy and microjejunostomy resulted in substantial clinical improvement. This case underscores three critical aspects of achalasia management: (1) the importance of early intervention, (2) the value of advanced surgical techniques, and (3) the necessity of a multidisciplinary approach for complex postoperative care. The unique surgical sequence employed in this case offers important insights for managing severe achalasia and highlights the ongoing need for research to optimize treatment strategies and long-term outcomes.