Achalasia complicated by multiple intramucosal carcinomas: report of a case.

A 56-year-old woman underwent a laparoscopic Heller-Dor operation for esophageal achalasia in June 2002. As dysphagia became exacerbated and the oral intake became extremely poor, an esophagectomy was thus considered to be indicated. In September 2005, a transhiatal esophagectomy was performed, and the esophagus was reconstructed using a gastric tube through the posterior mediastinum. The patient developed pneumonia postoperatively, but responded to conservative therapy and was discharged in good health 30 days after surgery. A histopathological analysis demonstrated degeneration and a loss of gangliocytes throughout the esophagus as well as the presence of seven intramucosal cancers. The main cause of dysphagia was due to a marked flexion of the upper esophagus. Even though we identified a precancerous state, we believe that surgery was an appropriate option in this case.