Terminal Esophageal (Vestibular) Spasm After Vagotomy

Abstract

Vagotomy, as a surgical approach to the treatment of peptic ulcer disease, was first described by Exner and Schwarzmann in 1912,¹but it has been primarily as a result of the more recent work of Dragstedt^2,3that this procedure has gained increasingly widespread acceptance. The occurrence of achalasia of the esophagus as a complication of vagotomy has received scant mention in the accumulating literature on this subject.^4-8Although this condition occurs most uniformly after cervical or high intrathoracic section of the vagus nerves in dogs,⁹it has only rarely been encountered after vagus section in man. Dragstedt attributes this to the fact that the vagi are usually divided only a short distance above the hiatus and has postulated that damage to the vagus nerves higher up might produce spasm of the cardia in man as it does in the lower animals. Ivy,¹⁰in discussing vagotomy,