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Case Reports in Surgery
Volume 2014, Article ID 654917, 5 pages
Case Report

Achalasia Secondary to Submucosal Invasion by Poorly Differentiated Adenocarcinoma of the Cardia, Siewert II: Consideration on Preoperative Workup

Dipartimento di Chirurgia Generale d’Urgenza e dei Trapianti d’Organo, U.O.C. Chirurgia Generale e d’Urgenza, Policlinico Universitario “Paolo Giaccone, ” Via Liborio Giuffrè 5, 90100 Palermo, Italy

Received 15 March 2014; Revised 22 June 2014; Accepted 24 June 2014; Published 15 July 2014

Academic Editor: Shin-ichi Kosugi

Copyright © 2014 Antonino Agrusa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Secondary achalasia due to submucosal invasion of cardia by gastric cancer is a rare condition. We report a case of pseudoachalasia, secondary to the involvement of gastroesophageal junction by poorly differentiated gastric cancer, initially mistaken as idiopathic form. We focus on the difficulty to establish differential diagnosis only on the basis of routine exams and we stress the necessity of “second level” instrumental exams; EUS in routine workup in selected patients should be considered. We support that routine workup based on history, clinical presentation, radiological and endoscopic findings, and certainly manometry could be insufficient for a correct differential diagnosis between primary and secondary forms in some patients.