Studija slučaja
https://doi.org/https://doi.org/10.64542/pc1.20.9
pulmonary rehabilitation after ivor lewis esophagectomy for end-stage achalasia
Snježana Benko Meštorvić
; KB Sveti Duh, Zagreb
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* Dopisni autor.
Sažetak
Background: Achalasia is a rare primary esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and absent or impaired esophageal peristalsis. Progressive esophageal dilatation may result in severe dysphagia, recurrent aspiration, respiratory complications, and, in selected patients with end-stage disease, the need for esophagectomy.
Case Presentation: A 46-year-old woman with end-stage achalasia underwent subtotal Ivor Lewis esophagectomy with intrathoracic esophagogastric anastomosis after progressive dysphagia and recurrent aspiration pneumonia. Three months after surgery, she presented with persistent dry cough, hoarseness, impaired breathing pattern, postoperative pain, and markedly reduced exercise tolerance. Baseline physiotherapeutic assessment demonstrated inspiratory muscle weakness, reduced peripheral muscle strength, and decreased functional exercise capacity, whereas ultrasonographic examination confirmed preserved diaphragmatic function. The patient subsequently completed a seven-week individualized outpatient pulmonary rehabilitation program comprising breathing retraining, inspiratory muscle training, aerobic exercise, and progressive resistance training.
Results: Following rehabilitation, maximal inspiratory pressure increased from 46 to 75 cmH₂O (51% to 83% of the predicted value), the 6-minute walk distance improved from 403 to 555 m, and bilateral handgrip strength increased from 18 to 26 kg. The patient also reported marked reductions in cough, postoperative pain, and dyspnea during physical activity. Persistent hoarseness was subsequently attributed to unilateral vocal cord paresis, and speech therapy was initiated.
Conclusion: This case demonstrates that a comprehensive pulmonary rehabilitation program may substantially improve respiratory muscle performance, functional exercise capacity, peripheral muscle strength, and postoperative symptoms following esophagectomy for end-stage achalasia.
Ključne riječi
achalasia; pulmonary rehabilitation; esophagectomy
Hrčak ID:
350475
URI
Datum izdavanja:
1.9.2026.
Posjeta: 0 *