Extreme Achalasia Presenting as Anorexia Nervosa. (4th October 2012)

• Record Type: Journal Article
• Authors: Goldsmith, P. J.; Decadt, B.
• Other Names: Ein S. H. Academic Editor.; Komenaka I. K. Academic Editor.; Rino Y. Academic Editor.
• Is Part Of: Case reports in surgery. Volume 2012(2012)
• Publication Date: 2012-10-04
• Subjects: Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; Surgical Procedures, Operative; General Surgery; Surgery; Electronic journals; Periodicals; Case studies; Periodicals; Case Reports; Fulltext; Internet Resources; Periodicals; 617
• DOI: 10.1155/2012/985454
• Languages: English
• ISSNs: 2090-6900

Abstract

Abstract : Background . Achalasia may lead to cachexia if not diagnosed in an early stage. Surgery in cachectic patients is hazardous and complications may result in a protracted recovery or even death. Different treatment options have been described. In this paper, we report a stepwise surgical laparoscopic approach which appears to be safe and effective. Methods . Over a one-year period, a patient with a body mass index (BMI) below 17 being treated for anorexia nervosa was referred with dysphagia. Because of the extreme cachexia, a laparoscopic feeding jejunostomy (LFJ) was fashioned to enable long-term home enteral feeding. The patient underwent a laparoscopic Heller myotomy (LHM) when the BMI was normal. Results . The patient recovered well following this stepwise approach. Conclusion . Patients with advanced achalasia usually present with extreme weight loss. In this small group of patients, a period of home enteral nutrition (HEN) via a laparoscopically placed feeding jejunostomy allows weight gain prior to safe definitive surgery.