Introduction
The gastrointestinal tract undergoes changes with aging, and the esophagus is not exempt from those changes. Presbyesophagus is the term used to describe the age-related changes in the esophagus, including decreased lower esophageal sphincter relaxation, incomplete dilatation of the esophagus, decrease in esophageal peristaltic pressure, abnormal esophageal contractions and delayed emptying of the esophagus. Adverse effects of aging likely contribute to the increased reports of choking spells and aspiration. Here we report a case of respiratory arrest of old woman after femur fracture operation, the cause of which was later diagnosed as presbyesophagus by VFSS.
Case report
An 88-year-old woman with a medical history of diabetes mellitus visited emergency room. She slipped down at home and she was diagnosed as a femur fracture. She was admitted to Orthopedic Surgery Department and received operation. She had no special complications related to the operation on that day. The next day she showed cyanosis during the meal. There was a pulse, but no breathing was found, and immediately the airway was opened and oxygen was supplied. After that, breathing was returned and she was transferred to the intensive care unit. There was no definite cause to cause respiratory arrest. So, the patient was referred to Rehabilitation Medicine Department for the evaluation of the cause of aspiration. On video fluoroscopic swallowing study (VFSS), there were no particular findings on the oral phase and the pharyngeal phase. On the esophageal phase, delayed emptying of the esophagus, abnormal esophageal contraction, and dilatation of the esophagus were found. The patient was referred to Gastroenterology Department to rule out presbyesophagus, achalasia, and abdominal masses. On endoscopy, there was dilatation of the esophagus, but lower esophageal tone was not increased. On esophagography, the esophagus did not show abnormal filling defects or barium collections. And there was delayed relaxation of the lower esophageal sphincter. Presbyesophagus was confirmed and the patient was recommended to start with liquid diet with the dyspepsia medicine. The patient had no special symptoms hospitalization, and was discharged to home.
Conclusion
We report a patient presenting respiratory arrest caused by presbyesophagus. Dysphagia has been reported in about 28.2% of the old people over 85 years. Dysphagia due to presbyesophagus, might become more severe after events such as surgery that could worsen general conditions. Any old people even without poor general conditions, we have to pay attention to dysphagia and further evaluation is warranted.
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