Laparoscopic surgery for an unusual case of dysphagia: lower oesophageal leiomyoma co-existing with achalasia cardia

Palanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV
Correspondence: Prof M Rangarajan, rangy68@gmail.com

ABSTRACT
Benign tumours of the oesophagus are rare, with an incidence of ten percent. Leiomyomas are the most common benign tumours and are located frequently in the middle and lower third of the oesophagus. Coexisting achalasia cardia is very rare. We present a 63-year-old man with coexisting leiomyoma and achalasia presenting with dysphagia for 25 days. Endoscopy and manometry revealed achalasia cardia at the lower third. Barium swallow showed a tumour proximal to the narrowing. Laparoscopic transhiatal enucleation and cardiomyotomy with Toupet fundoplication was successfully performed. Several conditions have been described to coexist with achalasia cardia, such as cancer, paraoesophageal hernia and hiatal hernia. Based on our experience, we feel that lower oesophageal tumours are best approached by a laparoscopic transhiatal route and the presence of achalasia in this case did not change the approach as cardiomyotomy with fundoplication could also be simultaneously performed. Minimally-invasive surgery for benign oesophageal tumours reduces the morbidity of thoracotomy or laparotomy.

Keywords: achalasia cardia, myotomy, oesophageal leiomyoma, transhiatal laparoscopical approach
Singapore Med J 2008; 49:e22-5.