Triple Luminal Challenge: Achalasia with Postcorrosive Esophageal and Antral Strictures Managed by Total Gastrectomy and Roux-en-Y Esophagojejunostomy

Achalasia may coexist with fixed postinflammatory stenoses after caustic ingestion, creating combined outflow obstruction. A 43-year-old female with long-standing achalasia – initially treated with two pneumatic dilations and later laparoscopic Heller myotomy with Dor fundoplication – deliberately ingested an HCl-based toilet cleaner (Harpic ® ) in November 2023 during a period of recurrent dysphagia and distress, sustaining Zargar 2A esophageal and Grade 3 gastric injury. Despite conservative care, she developed refractory dysphagia with a short-segment (≈2.5 cm) mid-to-distal esophageal stricture ~4 cm above the esophagogastric junction, dilated 7 → 11 mm, and a noncompliant antral ring. Functional imaging showed failure of gastric distension, rendering the stomach an unreliable reservoir. After nutritional optimization via feeding jejunostomy, she underwent total gastrectomy with Roux-en-Y esophagojejunostomy (EJ) and jejunojejunostomy. Recovery was uneventful; at 6 months, she tolerated a soft-regular diet with micronutrient supplementation, and endoscopy showed a patent EJ and healthy residual esophagus. When functional and cicatricial pathologies intersect, staged multidisciplinary care – including mental-health support – and an operation tailored to real-time anatomy/physiology are essential; long-term risk-adapted esophageal surveillance is warranted.