Megaesophagus and Possible Mechanisms of Sudden Death

• Published in: Journal of forensic sciences 2009-01, Vol.54 (1), p.216-219
• Main Authors: Schalinski, Sarah, Guddat, Saskia S., Tsokos, Michael, Byard, Roger W.
• Format: Article
• Language: English
• Subjects: achalasia; Aged; Aged, 80 and over; Airway Obstruction - etiology; Airway Obstruction - pathology; arrhythmia; Asphyxia - etiology; aspiration; Constriction, Pathologic - etiology; Death & dying; Death, Sudden - etiology; Esophageal Achalasia - pathology; Esophagus; Esophagus - pathology; Female; Forensic medicine; Forensic Pathology; forensic science; Heart Atria - pathology; Humans; Male; mechanisms; Medical disorders; megaesophagus; Respiration; Respiratory Aspiration - etiology; Respiratory Aspiration - pathology; sudden death
• ISSN: 0022-1198; 1556-4029
• DOI: 10.1111/j.1556-4029.2008.00912.x

:  Achalasia is a neurodegenerative condition characterized by esophageal dysmotility and megaesophagus. Two cases are reported that demonstrate unexpected deaths associated with previously unsuspected achalasia. Case 1: A 66‐year‐old woman was found dead at her home. At autopsy significant stenosing coronary artery atherosclerosis was found with cardiac failure. In addition, a striking finding was narrowing of the distal esophagus with marked proximal dilatation. The esophagus was completely filled with a large amount of soft masticated food and was bulging anteriorly, compressing the left atrium. Death was attributed to ischemic heart disease complicated by previously unsuspected achalasia. Case 2: An 84‐year‐old man collapsed and suffered a respiratory arrest while eating. Internal examination revealed narrowing of the cardioesophageal junction with marked proximal dilatation of the esophagus that contained approximately 50 mL of soft semi‐fluid masticated yellow food paste. Fragments of yellow masticated food remnants were present in upper and lower airways but not within the stomach. There was a history of dementia with symmetrical cerebral ventricular dilatation found at autopsy. Death was attributed to food asphyxia complicating previously unsuspected achalasia with dementia. Megaesophagus may, therefore, be a significant finding at autopsy that may either be a primary cause of unexpected death or else may exacerbate or compound the effects of pre‐existing underlying disease.