Plućna rehabilitacija nakon Ivor Lewis ezofagektomije u bolesnice s krajnjim stadijem ahalazije

Vollständiger Abstract

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Background: Achalasia is a rare primary esophageal motility disorder characterizedby impaired lower esophageal sphincter relaxation and absent or impaired esophagealperistalsis. Progressive esophageal dilatation may result in severe dysphagia, recurrentaspiration, 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 subtotalIvor Lewis esophagectomy with intrathoracic esophagogastric anastomosis after progressivedysphagia and recurrent aspiration pneumonia. Three months after surgery, shepresented with persistent dry cough, hoarseness, impaired breathing pattern, postoperativepain, and markedly reduced exercise tolerance. Baseline physiotherapeutic assessmentdemonstrated inspiratory muscle weakness, reduced peripheral muscle strength,and decreased functional exercise capacity, whereas ultrasonographic examinationconfirmed preserved diaphragmatic function. The patient subsequently completed aseven-week individualized outpatient pulmonary rehabilitation program comprisingbreathing retraining, inspiratory muscle training, aerobic exercise, and progressive resistancetraining.Results: Following rehabilitation, maximal inspiratory pressure increased from 46 to 75cmH₂O (51% to 83% of the predicted value), the 6-minute walk distance improved from403 to 555 m, and bilateral handgrip strength increased from 18 to 26 kg. The patient alsoreported marked reductions in cough, postoperative pain, and dyspnea during physicalactivity. Persistent hoarseness was subsequently attributed to unilateral vocal cord paresis,and speech therapy was initiated.Conclusion: This case demonstrates that a comprehensive pulmonary rehabilitationprogram may substantially improve respiratory muscle performance, functional exercisecapacity, peripheral muscle strength, and postoperative symptoms following esophagectomyfor end-stage achalasia.