Necrosis esofágica aguda en pacientes post trasplante hepático. Un túnel oscuro desde el hígado al esófago

2021 ◽  
Vol 51 (1) ◽  
Author(s):  
Gustavo Cernadas ◽  
Vanina Forestier ◽  
Karen Stave Salgado ◽  
Paola Coisson ◽  
Marylin Castilla ◽  
...  
Keyword(s):  
Gastroesophageal Junction ◽  
Esophageal Mucosa ◽  
Rare Entity ◽  
Proper Treatment ◽  
Acute Esophageal Necrosis ◽  
Support Measures ◽  
Vascular Compromise ◽  
Underlying Illness ◽  
Circumferential Distribution ◽  
Clinical Conditions

Acute esophageal necrosis is a rare entity endoscopically described as a black appearance of esophageal mucosa, generally of circumferential distribution that extends proximally from the gastroesophageal junction, and affects a variable length of this organ. It has a multifactorial etiology that includes a combination of ischemic mucosal esophageal vascular compromise associated with gastroesophageal reflux in patients with multiple comorbidities. Clinical management focuses on general support measures and treatment of the underlying illness and comorbidities. Although this pathology usually tends to a restitution-ad-integrum in 7-10 days, these patients have a high mortality rate more related to their clinical conditions and not due to this entity itself. Therefore, early diagnosis is crucial to initiate proper treatment. We present two cases of AEN in patients who underwent orthotopic liver transplantation.

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.

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 in the Setting of Alcohol Abuse after External Beam Radiation

2020 ◽  
Vol 14 (2) ◽  
pp. 443-447
Author(s):  
Smit S. Deliwala ◽  
Harini Lakshman ◽  
Douglas D. Congdon ◽  
Mamoon M. Elbedawi ◽  
Ghassan Bachuwa ◽  
...  
Keyword(s):  
Unusual Case ◽  
Gastroesophageal Junction ◽  
The Elderly ◽  
External Beam Radiation ◽  
Esophageal Mucosa ◽  
Beam Radiation ◽  
Acute Esophageal Necrosis ◽  
Clinical Disorder ◽  
Black Esophagus ◽  
Upper Gastrointestinal

Acute esophageal necrosis (AEN), black esophagus, or Gurvits syndrome is a rare clinical disorder characterized by a striking endoscopic appearance of necrotic esophageal mucosa, universally affecting the distal esophagus and ending abruptly at the gastroesophageal junction. It has been gaining traction as a demonstrable cause of upper gastrointestinal bleeding in the 21st century. Its pathophysiology is multifactorial affecting men and the elderly disproportionally, with a mortality rate nearing 36%. AEN has been associated with numerous conditions in the past, and we aim to present an unusual case of AEN on the setting of chronic alcohol use.

scholarly journals Acute Esophageal Necrosis (AEN) - A Rare Syndrome: Report of a Case in a Patient with an Underlying Malignancy and Review of the Literature

2020 ◽  
pp. 1-3
Author(s):  
Zenzola Víctor ◽  
Barranco Cao Raquel ◽  
Garzón Carlos ◽  
Herrera María ◽  
Molina Mercedes ◽  
...  
Keyword(s):  
Upper Gastrointestinal Bleeding ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Medical Disorder ◽  
Underlying Malignancy ◽  
Underlying Illness ◽  
Acute Necrotizing ◽  
Upper Gastrointestinal ◽  
Syndrome Report

Acute Esophageal Necrosis (AEN) is a rare medical disorder characterized by a diffuse circumferential black esophageal mucosa. The majority of patients present with signs of upper gastrointestinal bleeding. Diagnosis is based on esophagogastroduodenoscopy. Treatment consists of intravenous fluids, proton pomp inhibitors and treatment of the underlying illness. We report a case of acute necrotizing oesophagitis (AEN) with an underlying malignancy.

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.

scholarly journals Acute Esophageal Necrosis Secondary to a Paraesophageal Hernia

2021 ◽  
pp. 594-597
Author(s):  
Chris J. Li ◽  
Benjamin B. Claxton ◽  
Peter Block ◽  
Sean Reilly ◽  
Scott Manski ◽  
...  
Keyword(s):  
Paraesophageal Hernia ◽  
Gastric Volvulus ◽  
Gastrointestinal Symptoms ◽  
Antibiotic Use ◽  
Causative Factor ◽  
Low Flow ◽  
Barium Swallow ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis

Acute esophageal necrosis (AEN) or “black esophagus” is a rare clinical entity caused by necrosis of distal esophageal mucosa stemming from esophageal ischemia. Possible etiologies are broad but most commonly include possible triggers of low-flow vascular states in the esophagus, including infections, broad-spectrum antibiotic use, and gastric volvulus, among others. Patients most commonly present clinically with acute onset hematemesis and melena. Here, we describe a patient who initially presented with multiple nonspecific gastrointestinal symptoms, including abdominal pain and nausea, that progressed over a 10-day period, culminating in multiple episodes of hematemesis prior to presentation. Endoscopic evaluation confirmed the diagnosis of AEN and unveiled a possible paraesophageal hernia (PEH) as the causative factor. A subsequent videofluoroscopic barium swallow was utilized to better characterize the upper gastrointestinal anatomy and confirmed the PEH as a likely etiology. Esophagogastroduodenoscopy (EGD) can often identify PEH independently, but in patients with AEN secondary to a possible, but unclear, PEH on EGD, a videofluoroscopic barium swallow is an appropriate and useful next step in confirming the diagnosis. While treatment of AEN traditionally involves fluid resuscitation, intravenous protein pump inhibitors, and total parenteral nutrition, surgical intervention is often indicated in patients who have a contributing and symptomatic PEH.

S1990 Salivary Gland Choristoma in Gastroesophageal Junction: A Rare Entity

2020 ◽  
Vol 115 (1) ◽  
pp. S1040-S1040
Author(s):  
Yu Y. Nway ◽  
Ernesto Robalino Gonzaga ◽  
Parikh Jignesh ◽  
Vergeli-Rojas Jeannette
Keyword(s):  
Salivary Gland ◽  
Gastroesophageal Junction ◽  
Rare Entity

scholarly journals Mechanism of UES relaxation initiated by gastric air distension

2014 ◽  
Vol 307 (4) ◽  
pp. G452-G458 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Time Delay ◽  
Lower Esophageal Sphincter ◽  
Gastroesophageal Junction ◽  
Esophageal Pressure ◽  
Upper Esophageal Sphincter ◽  
Gastric Fistula ◽  
Esophageal Mucosa ◽  
Rapid Injection ◽  
Free Air ◽  
Esophageal Sphincter

The aim of this study was to determine the mechanism of initiation of transient upper esophageal sphincter relaxation (TUESR) caused by gastric air distension. Cats ( n = 31) were decerebrated, EMG electrodes were placed on the cricopharyngeus, a gastric fistula was formed, and a strain gauge was sewn on the lower esophageal sphincter ( n = 8). Injection of air (114 ± 13 ml) in the stomach caused TUESR ( n = 18) and transient lower esophageal sphincter relaxation (TLESR, n = 6), and this effect was not significantly ( P > 0.05) affected by thoracotomy. Free air or bagged air ( n = 6) activated TLESR, but only free air activated TUESR. Closure of the gastroesophageal junction blocked TUESR (9/9), but not TLESR (4/4), caused by air inflation of the stomach. Venting air from distal esophagus during air inflation of the stomach prevented TUESR ( n = 12) but did not prevent air escape from the stomach to the esophagus ( n = 4). Rapid injection of air on the esophageal mucosa always caused TUESR (9/9) but did not always (7/9) cause an increase in esophageal pressure. The time delay between the TUESR and the rapid air pulse was significantly more variable ( P < 0.05) than the time delay between the rapid air pulse and the rise in esophageal pressure. We concluded that the TUESR caused by gastric air distension is dependent on air escape from the stomach, which stimulates receptors in the esophagus, but is not dependent on distension of the stomach or esophagus, or the TLESR. Therefore, the TUESR caused by gastric air distension is initiated by stimulation of receptors in the esophageal mucosa.

scholarly journals Isolated Ascending Colon Varix: An Unusual Cause of Lower Gastrointestinal Bleed

2021 ◽  
Vol 12 (02) ◽  
pp. 116-117
Author(s):  
Jahnvi Dhar ◽  
Jayanta Samanta ◽  
Gaurav Muktesh ◽  
Rakesh Kochhar
Keyword(s):  
Portal Hypertension ◽  
Endoscopic Therapy ◽  
Gastroesophageal Junction ◽  
Clinical Suspicion ◽  
Rare Entity ◽  
Ascending Colon ◽  
Gastrointestinal Bleed ◽  
Ectopic Varices ◽  
Lower Gastrointestinal Bleed ◽  
The Common

AbstractEctopic varices, defined as dilated portosystemic veins located at unusual sites other than the gastroesophageal junction and fundus, have been reported in cases of cirrhosis with underlying portal hypertension. The common sites usually are the rectum and duodenum. Isolated colon varix is therefore a rare phenomenon and such varix presenting with lower gastrointestinal bleed as the first manifestation is still uncommon. A high index of clinical suspicion, timely imaging with full-length colonoscopy, and subsequent endoscopic therapy can effectively manage this rare entity.

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.

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