Table of Contents
ISRN Gastroenterology
Volume 2011 (2011), Article ID 871958, 5 pages
http://dx.doi.org/10.5402/2011/871958
Case Report

Diaphragmatic Hernia after Laparoscopic Esophagomyotomy for Esophageal Achalasia in Pregnancy

Department of Obstetrics & Gynecology, Cooper University Hospital, University of Medicine & Dentistry of New Jersey, 1 Cooper Plaza, 623 Dorrance Building, Camden, NJ 08103, USA

Received 13 September 2010; Accepted 7 October 2010

Academic Editors: J. N. Baxter, A. Nakajima, and H. Thorlacius

Copyright © 2011 Meena Khandelwal and Chad Krueger. 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.

Abstract

Background. The optimal treatment for management of esophageal achalasia in pregnancy is controversial. Little information exists about pregnancy outcome after successful myotomy. Case. Achalasia in pregnancy was diagnosed when a patient presented with pneumomediastinum from microrupture of the overdistended esophagus. An attempt at surgical correction failed due to the development of aspiration pneumonia with general anesthesia. Conservative medical therapy was undertaken, but fetal growth restriction developed. The patient underwent interval surgical correction, but subsequent pregnancy 6 months later was complicated by acute diaphragmatic hernia necessitating preterm delivery. Conclusion. Prior to surgery in pregnancy, emptying the dilated esophagus via nasoesophageal tube suctioning maybe warranted to avoid aspiration. Women, despite having undergone successful myotomy, should be counseled on the risks of pregnancy and to avoid pregnancy for at least 1 year thereafter.