The eight-year-old boy could no longer keep his meals down.
Every swallow of water stalled in his chest. Solid food proved impossible. Diagnosed with Type II achalasia—a crippling neuromuscular failure of the food pipe—the child faced a rapidly closing window for normal nutrition. Specialists at Rela Hospital in Chennai intervened, deploying an incisionless procedure known as Peroral Endoscopic Myotomy (POEM) to permanently unclamp the child's constricted digestive tract.
He resumed drinking clear fluids and eating soft food within 24 hours.
Achalasia is extraordinarily rare among children, striking an estimated 0.1 to 0.18 pediatric patients per 100,000 every year. The disease attacks the autonomic nerves controlling the esophagus. Without normal nerve firing, the lower esophageal sphincter—a muscular ring that serves as a one-way security gate between the food pipe and the stomach—locks tight. Food and fluids pool in the chest cavity, unable to slip past the spasm.
Traditional intervention long required open or laparoscopic surgery to slice the lower esophageal valve. POEM bypasses external cuts entirely.
Operating through the child’s mouth, Dr. S.N.K. Chenduran, senior consultant and endoscopic surgeon in Rela Hospital’s Department of Medical Gastroenterology, steered an endoscope down the throat. His team carved a microscopic tunnel directly inside the layers of the esophageal wall. Once inside that tissue channel, surgeons divided the misfiring, hyperactive muscle fibers strangling the passage, freeing the sphincter.
The entire operation took roughly 50 minutes.
| Clinical Parameter | Case Details |
|---|---|
| Patient Profile | 8-year-old male |
| Primary Diagnosis | Type II Achalasia |
| Pediatric Incidence | 0.1 to 0.18 cases per 100,000 children annually |
| Surgical Procedure | Peroral Endoscopic Myotomy (POEM) |
| Operating Time | Approximately 50 minutes |
| Incision Type | None (Endoscopic via mouth) |
| Post-Operative Feeding | Clear liquids and soft diet within 24 hours |
Operating on a pediatric patient demands exceptional technical restraint. "Performing POEM in children requires particular precision because of the smaller dimensions of the oesophagus and the delicate tissues," Dr. Chenduran said after the procedure.
Because the surgical team avoided external incisions and skin sutures, post-operative pain plummeted. The boy transitioned from IV hydration straight to oral sips of clear liquid the following morning, advancing to a soft diet before discharge.
Because achalasia presents so infrequently in young patients, families and primary care doctors frequently mistake early warning signs for basic acid reflux, behavioral food refusal, or recurring stomach bugs. Misdiagnosis often stretches over months while the child drops weight.
Persistent swallowing difficulties, regurgitation, vomiting, and unexplained weight loss in children warrant medical evaluation." > — Dr. Dinesh Jothimani, Director of Hepatology and Medical Gastroenterology at Rela Hospital
Pediatric gastroenterologists urge parents to track physical feeding milestones closely. When difficulty swallowing fluids follows solid food resistance, urgent diagnostic imaging—including esophageal manometry and specialized endoscopic evaluation—remains the baseline clinical protocol to protect long-term pediatric growth.