# Challenges in Diagnosis and Treatment of Achalasia Cardia in Uganda: A Case Report of an Adolescent Female Presenting With Dysphagia

## TL;DR

This case report describes the challenges of diagnosing and treating achalasia cardia in a young Ugandan woman, emphasizing the importance of early detection and careful management.

## Contribution

The paper presents a rare case of achalasia cardia in an adolescent from a resource-limited setting and highlights clinical and procedural challenges.

## Key findings

- Achalasia cardia was diagnosed in an 18-year-old Ugandan female through endoscopy and barium swallow.
- Esophageal perforation occurred during treatment but was successfully repaired, leading to symptom resolution after five months.
- The case underscores the need for clinical vigilance and informed consent in managing young patients with rare esophageal disorders.

## Abstract

Background: Our case highlights the challenges in diagnosing and managing achalasia cardia, particularly in resource-limited settings and more so in adolescents who fall outside of the typical age range.

Case Presentation: We present a case of an 18-year-old female from Uganda who was admitted with a 6-month history of progressive dysphagia, weight loss, and postprandial vomiting. Diagnosis of achalasia cardia was confirmed via endoscopy and barium swallow. Heller cardiomyotomy via open transthoracic approach was performed, but she developed an esophageal perforation, which was successfully managed with repeat thoracotomy and esophageal repair. Complete resolution of achalasia symptoms was achieved at a 5-month follow-up.

Conclusion: This case highlights the importance of maintaining a high index of clinical suspicion, especially in young patients, and the significance of informed consent prior to initiating treatment. Additionally, it emphasizes the importance of early recognition of treatment-related complications, such as esophageal perforation, as key to prompt management and improved patient outcomes.