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Secondary Achalasia and Other Esophageal Motility Disorders After Laparoscopic Nissen Fundoplication for Gastroesophageal Reflux Disease

Natasha E. Wehrli1, Marc S. Levine1, Stephen E. Rubesin1, David A. Katzka2 and Igor Laufer1

1 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
2 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.


Figure 1
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  		Fig. 1 —45-year-old man with secondary achalasia after laparoscopic Nissen fundoplication. Upright, left posterior oblique view from single-contrast upper gastrointestinal tract examination shows dilated esophagus with tapered, beaklike narrowing (black arrow) adjacent to gastroesophageal junction and delayed emptying of barium into stomach. There was no evidence of primary peristalsis at fluoroscopy. Clips (white arrows) are seen near gastroesophageal junction from recent fundoplication. Note dilution of barium by fluid in dilated esophagus more proximally.

 

Figure 2
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  		Fig. 2 —49-year-old man with secondary achalasia after laparoscopic Nissen fundoplication. Prone, right anterior oblique view from double-contrast upper gastrointestinal tract examination shows mildly dilated esophagus with beaklike narrowing (black arrow) of distal esophagus near gastroesophageal junction. There was no evidence of primary peristalsis at fluoroscopy. Note surrounding wrap (white arrows) from Nissen fundoplication, which made it difficult to assess lower esophageal sphincter opening.

 

Figure 3
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  		Fig. 3 —45-year-old woman with diffuse esophageal spasm after laparoscopic Nissen fundoplication. Upright, left posterior oblique view from single-contrast upper gastrointestinal tract examination shows numerous mild to moderate nonperistaltic contractions (arrows) in lower thoracic esophagus. There also was intermittent absence of primary peristalsis at fluoroscopy. Although no lumenobliterating contractions were observed, these findings are compatible with diffuse esophageal spasm.

 

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