PMC7516064_01
Depigmented patch with leucotrichia on A, the left hand, B, right hand C, lower quadrant of the abdomen D, right knee, right lateral malleolus.
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She had an appearance of multiple depigmented patches with sharply defined borders and leucotrichia on the neck, abdomen, hand, knee, and lateral malleolus (Fig. 1).
Upper gastrointestinal endoscopy findings showed dilatation of oesophagus with retained food caused by narrowing gastro oesophagus junction.
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The patient underwent an upper gastrointestinal endoscopy and showed dilatation from distal oesophagus (38 cm from incisors) with retained food caused by narrowing gastro oesophagus junction (Fig. 2).
A, Chest X-Ray showed convex opacity overlapping the right mediastinum and absent of gastric bubble. B, Computed Tomography Scan Thorax showed severe dilatation of oesophagus (diameter 4-7 cm) with narrowing in the distal level of gastrooesophagus sphincter.
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Computed Tomography Scan Thorax revealed severe dilatation of oesophagus (diameter 4-7 cm) with narrowing in the distal level of gastrooesophagus sphincter, intraluminal fluid, shifting trachea to the right, shifting thyroid lobes to anterior and shifting left carotid artery to posterolateral left (Fig. 3).
Laparoscopic view. Heller myotomy was performed with oesophagus side 5 cm to proximal and gastric side 2 cm to distal, Dor fundoplication was performed for anti-reflux and to cover the exposed submucosa.
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After the myotomy was made and leak testing was done with blowing the nasogastric tube, the opening of the esophagus was repaired with Dor's fundoplication (Fig. 4).
Post-operative A, Barium swallow on postoperative day 5 barium showed no narrowing in oesophagus gastric junction at the distal oesophagus, no leakage from oesophagus to jejunum. B, Upper gastrointestinal endoscopy findings showed a reduction in sigmoid shape, no esophagitis, good condition of LOS, and polyp 2 mm presented in the gastric corpus.
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A post-operative study with a barium swallow of upper gastrointestinal radiograph was carried out 5 days following surgery, in which passage from oesophagus to jejunum without leakage, and no narrowing in oesophagus gastric junction at the distal oesophagus (Fig. 5A). Five months later the patient presented back with improvement were observed in upper gastrointestinal endoscopy, with a reduction in the sigmoid shape of oesophagus, good condition of LOS, and polyp 2 mm presented in the gastric corpus (Fig. 5B).