End-stage achalasia leading to acute upper airway obstruction and respiratory arrest with successful resuscitation, a case report

Respiratory arrest secondary to megaoesophagus is a rare complication of achalasia. We treated an 85-year-old female with a history of achalasia who presented with sudden respiratory arrest and cardiopulmonary resuscitation in the community. In the emergency department, she was intubated for respiratory distress secondary to upper airway obstruction and reduced consciousness. Flexible nasal endoscopy revealed a retropharyngeal bulge, and computed tomography (CT) demonstrated megaoesophagus with distal tapering. She was managed with gastric decompression and percutaneous endoscopic gastrostomy (PEG) feeding with an uncomplicated hospital course. This case provides a rare differential for a patient with acute upper airway obstruction and cardiopulmonary arrest and is the first such case described in the literature in Aotearoa New Zealand.