Background Hemangiopericytomas (HPCs) are rare tumors derived from mesenchymal cells with pericyte differentiation. About 5% of head and neck HPCs occur in the nasal cavity and paranasal sinuses. Due to its rarity, rich vascularity and variable biological behavior, its management is a challenge in itself. Case We report a case of sinonasal HPC in a Jehovah's Witness patient and discuss the obstacles and care related to the restrictions and therapeutic challenges involved in the approach to the patient. The patient was successfully treated by endoscopic endonasal approach with all per‐operative care and restrictions being respected and attended. Conclusions The management of HPC by itself involves challenges and when associated with other restrictive conditions attention and care are required.

o objetivo foi relatar um caso de megaesôfago idiopático que foi tratado por cardiomiotomia videolaparoscópica a Heller-Pinotti em um paciente masculino, de 29 anos. Foi realizada triagem inicial com anamnese e exame físico e o paciente alegou disfagia progressiva sem alterações dos hábitos intestinais associadas; exame físico abdominal sem alterações. A investigação diagnóstica laboratorial incluiu tireoideopatia, doença de Chagas e doença do refluxo gastroesofágico. Após extensa investigação foi detectada acalasia (confirmada por esofagomanometria) idiopática, sendo assim realizada a cardiomiotomia videolaparoscópica a Heller-Pinotti. Posteriormente ao tratamento cirúrgico, o paciente apresentou boa evolução pós-operatória, não havendo queixas de pirose ou regurgitação e desaparecendo a queixa de disfagia. Declara-se boa experiência com o tratamento cirúrgico proposto, no entanto, novos estudos se tornam necessários para aprimoramento da técnica cirúrgica e consequente maior benefício para o paciente com acalasia idiopática.   the goal was to report a case of idiopathic achalasia that was treated by Heller-Pinotti’s videolaparoscopic cardiomyotomy in a male patient of 29 years. The initial assessment was done with clinical history and physical examination and the patient claimed progressive dysphagia without changes in bowel habits associated; abdominal physical examination without abnormalities. Laboratory diagnostic investigation included thyroidopathy, Chagas’ disease and gastroesophageal reflux disease. After extensive research, it was detected idiopathic achalasia (confirmed by esophageal manometry) and Heller- Pinotti’s videolaparoscopic cardiomyotomy was realized. After surgery, the patient presented good postoperative evolution, with no complaints of heartburn or regurgitation and the dysphagia complaint had gone. We can declare good experience with the proposed surgical treatment, however, further studies are needed to make improvements in surgical technique and consequent greater benefit to the patient with idiopathic achalasia.