Recurrent gastric carcinoma causing pseudoachalasia: case report

We report the case of a patient with a gastric remnant relapse of an antral carcinoma resected 5 years before and presenting with the clinical feature of a secondary achalasia (pseudoachalasia). In spite of the patient's 4-month history of dysphagia and weight loss that suggested a malignant lesion, barium swallow, repeated endoscopic biopsies and computed tomography (CT) scan of the upper abdomen did not reveal any abnormalities to indicate a recurrence. However, in the following months, because of worsening symptoms, a further CT scan was performed and revealed thickening of the cardia and gastric wall. The patient underwent an exploratory laparotomy that showed an unresectable lesion involving the gastric fundus, the diaphragm and penetrating into the mediastinum, and therefore a palliative jejunostomy was performed.