Acute airway obstruction secondary to achalasia mega-oesophagus

Acute airway obstruction is a very rare presentation of achalasia. We report the case of a 78-year-old woman with previously undiagnosed achalasia who presented with acute respiratory distress and stridor due to tracheal compression by mega-oesophagus. Anaesthetists and physicians caring for patients with achalasia must be aware of the need for emergency oesophageal decompression in this rare and life-threatening condition.