scholarly journals Acute esophageal necrosis: A rare case of upper gastrointestinal bleeding from diabetic ketoacidosis

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Dustin J. Uhlenhopp ◽  
Gregory Pagnotta ◽  
Tagore Sunkara
Keyword(s):  
Diabetic Ketoacidosis ◽  
Gastroesophageal Junction ◽  
Stable Condition ◽  
Rare Condition ◽  
Critically Ill Patient ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Acute Necrotizing ◽  
Upper Gastrointestinal

Acute esophageal necrosis, also known as black esophagus or acute necrotizing esophagitis is a rare condition with roughly 154 cases reported in the literature. This condition is classically diagnosed on its endoscopic findings of a circumferentially black esophagus that abruptly ends at the gastroesophageal junction and transitions to normal gastric mucosa. When present, acute esophageal necrosis potentially signifies a poor prognosis with an overall mortality up to 36%. This case report describes a critically ill patient with multiple comorbidities that was found to have acute esophageal necrosis the entire length of the esophagus secondary to ischemia/hypoperfusion that was caused by diabetic ketoacidosis. The patient had a prolonged hospitalization but was ultimately discharged in stable condition. We also review the literature of this rare esophageal condition.

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 An Unusual Cause of Acute Upper Gastrointestinal Bleeding: Acute Esophageal Necrosis

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Nikhil R. Kalva ◽  
Madhusudhan R. Tokala ◽  
Sonu Dhillon ◽  
Watcoun-Nchinda Pisoh ◽  
Saqib Walayat ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Clinical Presentation ◽  
Upper Gastrointestinal Bleeding ◽  
Gastroesophageal Junction ◽  
Atherosclerotic Cardiovascular Disease ◽  
Acute Esophageal Necrosis ◽  
Endoscopic Findings ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Upper Gastrointestinal

Acute esophageal necrosis (AEN), also called “black esophagus,” is a condition characterized by circumferential necrosis of the esophagus with universal distal involvement and variable proximal extension with clear demarcation at the gastroesophageal junction. It is an unusual cause of upper gastrointestinal bleeding and is recognized with distinct and striking mucosal findings on endoscopy. The patients are usually older and are critically ill with shared comorbidities, which include atherosclerotic cardiovascular disease, diabetes mellitus, hypertension, chronic renal insufficiency, and malnutrition. Alcoholism and substance abuse could be seen in younger patients. Patients usually have systemic hypotension along with upper abdominal pain in the background of clinical presentation of hematemesis and melena. The endoscopic findings confirm the diagnosis and biopsy is not always necessary unless clinically indicated in atypical presentations. Herein we present two cases with distinct clinical presentation and discuss the endoscopic findings along with a review of the published literature on the management of AEN.

scholarly journals Black esophagus: A case of acute esophageal necrosis associated with diabetic ketoacidosis

2021 ◽  
Author(s):  
Daisuke Kitawaki ◽  
Atsushi Nishida ◽  
Keitaro Sakai ◽  
Yuji Owaki ◽  
Kyohei Nishino ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Diabetic Ketoacidosis ◽  
Upper Gastrointestinal Bleeding ◽  
Clinical Disease ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Threatening Condition ◽  
Life Threatening ◽  
Upper Gastrointestinal

Acute esophageal necrosis (AEN), commonly referred to as “black esophagus”, is a rare clinical disease. Though AEN remains a rare cause of upper gastrointestinal bleeding, it is a potentially life-threatening condition. We present a case of AEN associated with diabetic ketoacidosis.

scholarly journals Acute Esophageal Necrosis and Low-Flow State

2007 ◽  
Vol 21 (4) ◽  
pp. 245-247 ◽  
Author(s):  
Ahmad Burtally ◽  
Philippe Gregoire
Keyword(s):  
Gastroesophageal Junction ◽  
Low Flow ◽  
Quebec City ◽  
Flow State ◽  
Present Case Report ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Proximal Extension ◽  
Clinical Conditions

Acute esophageal necrosis (AEN), also called black esophagus, is quite exceptional. Endoscopic findings show circumferential black discolouration of the esophagus with or without exudates. The etiology of AEN is presently unknown and is assumed to be multifactorial. Distal esophageal involvement with proximal extension ending sharply at the gastroesophageal junction is the most common presentation. The present case report describes the clinical and endoscopic evolution of black esophagus observed in a patient with significant peripheral vascular disease, who was presented to the intensive care unit at the Hopital Saint-Francois d’Assise (Quebec City, Quebec). Through an extensive review of the literature, common underlying clinical conditions of patients diagnosed with AEN have been identified.

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

scholarly journals Acute esophageal necrosis (black esophagus) with active upper gastrointestinal bleeding: What to do?

Endoscopy ◽  
2021 ◽  
Author(s):  
Igor Braga Ribeiro ◽  
Gustavo de Oliveira Luz ◽  
Gabriel Mayo Vieira de Souza ◽  
Mateus Bond Boghossian ◽  
Epifânio Silvino do Monte Junior ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Upper Gastrointestinal

scholarly journals Black esophagus: acute esophageal necrosis complicating diabetic ketoacidosis

2018 ◽  
Vol 190 (35) ◽  
pp. E1049-E1049 ◽  
Author(s):  
Hourmazd Haghbayan ◽  
Avijeet K. Sarker ◽  
Eric A. Coomes
Keyword(s):  
Diabetic Ketoacidosis ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus

scholarly journals Acute Esophageal Necrosis (Gurvits Syndrome): A Rare Complication of Diabetic Ketoacidosis in a Critically Ill Patient

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Linda P. Vien ◽  
Ho-Man Yeung
Keyword(s):  
Diabetic Ketoacidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Rare Complication ◽  
Oral Intake ◽  
Critically Ill Patient ◽  
Dependent Diabetes Mellitus ◽  
Upper Gastrointestinal Endoscopy ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis

Acute esophageal necrosis (AEN) is a rare clinical diagnosis that primarily affects the distal third of the esophagus. AEN causes odynophagia, leading to decreased oral intake and food avoidance. AEN can arise in critically ill patients with multiple comorbidities and is an uncommon complication of diabetic ketoacidosis (DKA). We present a case of a young female with poorly controlled, insulin-dependent diabetes mellitus type 2 who developed odynophagia, small volume coffee-ground emesis, and inability to tolerate oral intake after resolution of DKA. She was found to have esophagitis with esophageal necrosis in the middle third of the esophagus on upper gastrointestinal endoscopy. She was subsequently treated with fluid resuscitation and gastric acid suppression and improved clinically with slow advancements in her diet. The location of her lesion in the more vascularized middle one-third of the esophagus and lack of significant blood pressure variations during her hospital stay make her case unique. Thus, AEN should be considered in the differential diagnosis for critically ill patients who present with vague symptoms such as odynophagia and gastrointestinal bleeding.

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