scholarly journals Black Esophagus in the Setting of Diabetic Ketoacidosis: A Rare Finding from Our Institution

2019 ◽  
Vol 13 (3) ◽  
pp. 475-480
Author(s):  
Sara Ghoneim ◽  
Aun Shah ◽  
Shaman Dalal ◽  
Marc Landsman ◽  
Annette Kyprianou
Keyword(s):  
Diabetic Ketoacidosis ◽  
Case Series ◽  
Acid Reflux ◽  
Esophageal Mucosa ◽  
Upper Endoscopy ◽  
Acute Esophageal Necrosis ◽  
Rare Finding ◽  
Black Esophagus ◽  
Autopsy Series ◽  
Black Discoloration

Acute esophageal necrosis (AEN) is defined as necrosis of the esophageal mucosa seen as diffuse black discoloration of the distal esophagus on an upper endoscopy. The prevalence of the disease is rare and reported to be up to 0.2% in autopsy series. The etiology of the disease is thought to be multifactorial and due to ischemic insults to the esophagus with gastric acid reflux further damaging the vulnerable mucosa. Patients are often critically ill or with significant comorbidities. Here, we present a case series of 3 patients with AEN induced by diabetic ketoacidosis.

scholarly journals Acute Esophageal Necrosis in a Septic Patient with a History of Cardiovascular Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Michael Coles ◽  
Victoria Madray ◽  
Pearl Uy
Keyword(s):  
Cardiovascular Disease ◽  
Gallstone Pancreatitis ◽  
Esophageal Mucosa ◽  
Upper Endoscopy ◽  
Endoscopic Retrograde ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
History Of ◽  
Gi Bleed

Acute esophageal necrosis (AEN), or colloquially named “black esophagus,” is a rare clinical condition often associated with ischemic injury to the esophagus secondary to splanchnic vasoconstriction during hypotensive episodes. We present a case of a 78-year-old man with extensive cardiovascular disease who was initially admitted for gallstone pancreatitis and possible cholangitis. His hospital course was complicated by possible sepsis secondary to aspiration pneumonia and hematemesis secondary to acute ischemic esophageal necrosis as noted on upper endoscopy. Interestingly, the patient only had a transient episode of hypotension (approximately 35 minutes) not requiring vasopressor support, which improved with fluid resuscitation, and endoscopic retrograde cholangiopancreatography (ERCP) done 3 days prior showed normal esophageal mucosa. Clinicians should be aware of the possibility of acute esophageal necrosis as a potential etiology of gastrointestinal (GI) bleed in patients with cardiovascular disease and sepsis.

Acute Esophageal Necrosis (Black Esophagus): An Autopsy Case Series

2021 ◽  
Vol 11 (3) ◽  
pp. 115-125
Author(s):  
Lauren R. Crowson-Hindman ◽  
Keenen Smith ◽  
Angelina Phillips
Keyword(s):  
Gastroesophageal Junction ◽  
Case Series ◽  
Background Information ◽  
Unknown Etiology ◽  
Pathologic Finding ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Acute Necrotizing

Introduction: Acute esophageal necrosis (AEN), also known as black esophagus and acute necrotizing esophagitis, is a rare pathologic finding of unknown etiology. It was first characterized as diffuse, circumferential black discoloration of the esophageal mucosa that affects predominantly the distal esophagus with sharp transition to normal-appearing mucosa at the gastroesophageal junction. Case frequency of AEN remains low and mainly found incidentally, with up to 0.2% in autopsy and endoscopy studies. Men are 4 times more commonly affected and overall mortality is approximately 32%. Methods: Black esophagus was incidentally found during ten forensic autopsy cases. Complete autopsies with photographs, histological examination, and toxicological analysis were performed. Case background information was reviewed. A review of literature was done, with research criteria including previous case reports, diagnosis, and autopsy, endoscopic, and microscopic findings of AEN. Results: Nine of ten deceased were male, with an age range of 26 to 67 years old. The most common preexisting pathological condition was chronic alcohol consumption, seen in six of ten cases, and in eight cases, the death occurred suddenly at home. “Classic” black esophagus was only seen in four cases. Upper gastrointestinal hemorrhage due to acute necrotizing esophagitis was established as the immediate cause of death in six of ten cases. Discussion: This case series demonstrates ten cases of AEN with variation in appearance, yet diagnosis supported by histology, ancillary testing, and case information. The case frequency was higher than previously reported, 0.7%, suggesting that the prevalence of AEN may be underestimated, especially in forensic death investigations.

scholarly journals “Black Esophagus” or Gurvits Syndrome: A Rare Complication of Diabetic Ketoacidosis

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Vivek Choksi ◽  
Kairavee Dave ◽  
Rulz Cantave ◽  
Sameer Shaharyar ◽  
Jeevan Joseph ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Diabetic Ketoacidosis ◽  
High Mortality ◽  
Rare Complication ◽  
Gastroesophageal Junction ◽  
Distal Esophagus ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Black Esophagus ◽  
Sixth Decade

Acute esophageal necrosis (AEN) also known as “black esophagus” or necrotizing esophagitis is a rare syndrome characterized by a striking diffuse patchy or circumferential black appearance of the esophageal mucosa that preferentially affects the distal esophagus and terminates at the gastroesophageal junction. Only 88 patients over a span of 40 years have received this diagnosis, and the prevalence of this disease ranges from 0.001 to 0.2% of cases in literature. It more commonly affects men (4 : 1 ratio) in the sixth decade of life. It is associated with a high mortality rate, approaching 32%. We report a case of AEN presenting in the setting of diabetic ketoacidosis (DKA), affecting both the proximal and distal esophagus.

An Under-Appreciated Manifestation of Sepsis and Diabetic Ketoacidosis, the Black Esophagus: A Case Series

2017 ◽  
Vol 112 ◽  
pp. S944-S946
Author(s):  
Alok Tripathi ◽  
Birju Shah ◽  
Sarmad Jassim ◽  
Salman Ayub ◽  
Daryl J Thornton ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Case Series ◽  
Black Esophagus

scholarly journals Acute Esophageal Necrosis Early after Renal Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ahmad Makeen ◽  
Faisal Al-Husayni ◽  
Turki Banamah
Keyword(s):  
Blood Pressure ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Graft Loss ◽  
Low Flow ◽  
Esophageal Mucosa ◽  
Flow State ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Discoloration

Background. Acute esophageal necrosis (AEN) is defined as a diffused black discoloration of the esophageal mucosa involving mainly the distal part of the esophagus. It is considered a rare clinical entity with a high mortality rate. The etiology of AEN is unknown, but it has been correlated to many causes such as malignancies, infections, and hemodynamics instability. Here, we report a case of a patient developing AEN a few days after kidney transplantation. Case Presentation. A 57-year-old male was admitted electively for kidney transplantation that he received from his son. The surgery was complicated with a significant drop in blood pressure but otherwise was uneventful. The patient was showing good signs of recovery but then suffered from significant hematemesis. An urgent upper esophagogastroduodenoscopy revealed black discoloration of the esophageal mucosa in keeping with AEN. The patient was treated with proton pump inhibitors infusion and started empirically on antivirals and antifungals. The patient’s condition improved in regards to the AEN; nonetheless, the complications resulted in graft loss, and the patient returned to hemodialysis. Conclusion. AEN is a critical condition that mandates early intervention. Identifying high-risk populations may aid in early anticipation and diagnosis. Patients with chronic kidney disease are at risk of atherosclerosis leading to a low flow state which is exacerbated during renal transplantation surgery, especially if the procedure was complicated with a drop in blood pressure.

scholarly journals Black Esophagus: A Rare Case of Acute Esophageal Necrosis Induced by Diabetic Ketoacidosis in a Young Adult Female

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Zachary Field ◽  
Jacqueline Kropf ◽  
Meghan Lytle ◽  
Giselle Castaneira ◽  
Mario Madruga ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Outlet Obstruction ◽  
Distal Esophagus ◽  
Fluid Loss ◽  
Acute Esophageal Necrosis ◽  
Clinical Disorder ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Poor Nutritional Status ◽  
Older Males

Background. Acute esophageal necrosis is an uncommon clinical disorder diagnosed on endoscopy as a black esophagus. It has a multifactorial etiology that probably represents a combination of poor nutritional status, gastric outlet obstruction, and ischemia secondary to hypoperfusion of the distal esophagus. It typically occurs in older males with comorbidities. Case. A 37-year-old woman presented with diabetic ketoacidosis and hematemesis. At esophagogastroduodenoscopy acute esophageal necrosis was diagnosed. The treatment included fluid and electrolyte management, insulin, and a proton pump inhibitor. She improved and left the hospital on day 3. Conclusion. Diabetic ketoacidosis can result in a profound osmotic diuresis, fluid loss, and hypoperfusion of the distal esophagus. This condition can then lead to ischemic injury and acute esophageal necrosis. Awareness of the possibility of its presence in young women with hematemesis and poorly controlled diabetes is important since early identification with esophagogastroduodenoscopy is necessary to prevent serious postnecrotic complications.

scholarly journals A199 BLACK ESOPHAGUS: AN UNDER-RECOGNIZED CAUSE OF UPPER GASTROINTESTINAL BLEEEDING

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 72-73
Author(s):  
A Arora ◽  
K Tsoi
Keyword(s):  
Gastrointestinal Bleeding ◽  
Nasogastric Tube ◽  
Upper Gastrointestinal Bleeding ◽  
Diabetic Patients ◽  
Upper Endoscopy ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Coffee Ground ◽  
Upper Gastrointestinal

Abstract Background “Black esophagus” is a term that refers to the endoscopic manifestation of acute esophageal necrosis (AEN), a rare but potentially under-recognized cause of upper gastrointestinal bleeding, characterized by the presence of strikingly black necrotic esophagus on upper endoscopy. The etiology is unclear although ischemic insults and caustic injury from gastric acid exposure are thought to play prominent roles. This condition is often seen in patients who are systemically unwell and have underlying comorbidities such as diabetes mellitus and vascular diseases. Aims We present a case of an elderly woman with diabetes and poor glycemic control who developed coffee ground emesis with her upper endoscopy revealing evidence of acute esophageal necrosis. AEN is an important diagnosis to consider in diabetic patients, as it generally carries a poor prognosis with mortality rates as high as 32% reported in the literature. Methods Case report and review of the literature Results A 61-year-old woman with medical history significant for poorly controlled insulin dependent diabetes (hemoglobin A1c, 11%) developed coffee ground emesis (confirmed via insertion of nasogastric tube) three days after initial admission to hospital for left tibial plateau fracture. Her bloodwork did not reveal any underlying diabetic ketoacidosis or hyperosomlar hyperglycemic state. Her esophagogastroduodenoscopy (EGD) showed black, necrotic-appearing discoloration of the esophageal mucosa circumferentially within the mid to distal part of the esophagus with a sharp transition point towards normal appearing mucosa at the gastroesophageal junction. Biopsies were deferred due to high risk of bleeding and perforation, and the previously placed nasogastric tube was not removed. After endoscopy, conservative management was advised with restricted oral intake, intravenous proton pump inhibitor (PPI) inhibitor therapy for 72 hours and aggressive treatment of ongoing hyperglycemia. There were no signs or symptoms of esophageal rupture. The patient gradually recovered and in fact had her orthopedic surgery within a week of EGD. Furthermore, three days into the post operative period she developed venous thromboembolism and was placed on full dose oral anticoagulation and tolerated this without any further gastrointestinal bleeding. Conclusions AEN is an important diagnostic consideration in elderly diabetic patients presenting with acute upper gastrointestinal bleeding, particularly as timely recognition and management can significantly lower the unfavorable mortality associated with this condition. Funding Agencies None

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