Diagnosis and treatment of achalasia of the cardia, initially regarded as a hernia of the esophageal orifice of the diaphragm

The article presents the treatment outcome of a female patient with achalasia cardia, mistakenly diagnosed as a hiatal hernia. Clinical case. Patient B., 50, underwent two surgical interventions for dysphagia, mistakenly diagnosed as a hiatal hernia. Despite the surgeries, symptoms persisted and steadily progressed. High-resolution manometry confirmed the diagnosis of type I achalasia cardia. Based on the results of a comprehensive follow-up examination, a decision was made to remove the fundoplication cuff and perform peroral endoscopic myotomy (POEM) as the final stage of functional correction. Postoperatively, adequate enteral nutrition was restored, and the patient’s quality of life significantly improved. Results. Persistent restoration of esophageal passage, complete resolution of dysphagia and regurgitation, were noted. Nutritional status and quality of life were fully restored. No recurrences of symptoms or need for repeat interventions were observed during the observation period. Conclusion. Antireflux surgeries for undiagnosed achalasia lead to severe dysphagia, requiring complex, multi-stage correction. Preoperative manometry is essential in the differential diagnosis of dysphagia.