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Respiratory Arrest Following Foreign Body Aspiration in Achalasia: A Case Report

Saad Khan1,2*, Rex Shih-Chia Huang3, Nuha Khan4 and Danae Papachristos5

1Department of Gastroenterology, Peninsula Health, Frankston, Victoria, Australia

2Department of Medicine, Austin Health, Heidelberg, Victoria, Australia

3Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia

4Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia

5Department of Medicine, St Vincent’s Hospital, Fitzroy, Victoria, Australia

*Corresponding Author:
Saad Khan
Department of Gastroenterology
Peninsula Health, Frankston, Victoria, Australia
Tel: 61 403 798 622
E-mail: s.khan23@hotmail.com

Citation: Khan S, Huang RS, Khan N, Papachristos DA. Respiratory Arrest Following Foreign Body Aspiration in Achalasia: A Case Report. Arch Med. 2015, 7:3.

 
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Keywords

Foreign body aspiration, achalasia

Case Report

An 84-year-old man presented with acute respiratory distress thought secondary to aspiration pneumonia. Although limited to a seated study, a recent barium swallow showed esophageal dilatation associated with low amplitude tertiary waves. This was secondary to a tight and smooth narrowing in the distal esophagus consistent with achalasia [1] (Figure 1a).

archivesofmedicine-Distal-esophagus

Figure 1A and 1B: (1A) Distal esophagus consistent with achalasia.; (1B) Bronchoscopy.

Pulse oximetry on a fraction of inspired oxygen of 21% showed a reduced saturation of peripheral oxygen at 86%. Respiratory examination revealed reduced air entry at the right base, but no stridor. Chest X-ray did not reveal any abnormalities. His respiratory status deteriorated despite appropriate antimicrobial, anti-inflammatory and bronchodilator therapy.

Bronchoscopy was performed due to a high clinical suspicion of foreign body aspiration and this showed a tablet in the right main bronchus (Figure 1b) that disintegrated on attempted retrieval. Following the procedure the patient required invasive ventilation via tracheostomy and was eventually palliated following discussion with family. Significant complications of foreign body aspiration in adults have been reported, including obstructive pneumonitis, atelectasis, bronchiectasis and lung abscess [2]. Although rare, achalasia has a well-recognized association with foreign body aspiration [3-5] and a high index of suspicion is required to ensure appropriate management.

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