Pseudoachalasia due to hepatic compression in an adolescent: A case of enlarged left and accessory liver lobes

Abstract

Background: Achalasia cardia is a rare oesophageal motility disorder characterized by impaired lower oesophageal sphincter (LES) relaxation and absent peristalsis. While typically idiopathic, rare cases arise from external compression.

Case Presentation: We report an 18-year-old male with a two-year history of progressive dysphagia to liquids and solids, chest pain, regurgitation, and weight loss. Barium swallow revealed oesophageal dilation with tapering ("bird's beak" sign). Definitive diagnosis was made intraoperatively, which revealed an enlarged left liver lobe and an accessory lobe compressing the distal oesophagus.

Intervention: A modified Heller's oesophagocardiomyotomy was performed via laparotomy.

Conclusion: This case highlights a rare cause of pseudoachalasia due to hepatic compression and underscores the importance of considering extrinsic causes in atypical achalasia, especially in resourcelimited settings.