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Pseudoachalasia, clinically indistinct from achalasia in symptoms and high-resolution manometry findings, differs by a secondary etiology with more than half of the occurrences arising from malignancy. Rarely pseudoachalasia presents after surgeries of the esophagus and gastroesophageal junction. This case offers an additional example of pseudoachalasia after Nissen fundoplication; however, it is unique to the literature by documenting complete manometric progression from normal to pseudoachalasia in a single patient. This case serves to highlight the importance of thorough workups in patients with achalasia symptoms and broadens understanding of this disease process by offering manometric findings in an evolutionary phase.

Metastasis of colon adenocarcinoma is commonly found in the lung, liver, or peritoneum. Common bile duct (CBD) tumors related to adenomas from familial adenomatous polyposis metastasizing from outside of the gastrointestinal tract have been reported. We report a case of biliary colic due to metastatic colon adenocarcinoma to the CBD. Obstructive jaundice with signs of acalculous cholecystitis on imaging in a patient with a history of colon cancer should raise suspicion for metastasis to CBD.

A 50-year-old man with a history of epilepsy controlled with phenytoin presented for evaluation of dysphagia. History revealed the patient was taking his phenytoin daily without water. Barium esophagram showed severe stricturing of the mid-esophagus. Upper endoscopy revealed diffuse gross mucosal abnormality with a thick stricture and occasional exudate. Biopsies were consistent with a drug-induced injury with lymphocytic infiltration and epithelial cell necrosis.