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Pneumonitis after regurgitation and aspiration resulting from achalasia – a case report

Achalasia is a motor disorder of the esophageal smooth muscle in which the lower esophageal sphincter (LES) does not relax properly with swallowing, and the normal esophageal peristalsis is replaced by abnormal contractions. Patients with achalasia are at increased risk for development of regurgitation and aspiration during anesthesia. We report a case of a patient who developed pulmonary infiltrate after aspiration during anesthesia. The patient became febrile and developed pulmonary infiltrate considered as pneumonia. Antibiotic therapy was initiated immediately. However, fast recovery and regression of the infiltrate suggested that the lung process was pneumonitis and not pneumonia. Antibiotic therapy was discontinued, and the patient recovered completely. The problem of regurgitation in patients with achalasia demands additional caution in anesthesia induction. The difference between pneumonia and pneumonitis is crucial in treatment approach.

achalasia, regurgitation, aspiration, pneumonitis, anesthesia

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