Acute Esophageal Necrosis in Acute Pancreatitis—Report of a Case and Endoscopic and Clinical Perspective

Abstract

Esophageal stroke, also known as acute esophageal necrosis or Gurvits syndrome, is an entity that has gained more and more recognition in the last two decades. It is also named “black esophagus” because of striking black discoloration of the esophageal mucosa, with an abrupt transition to normal mucosa at the gastroesophageal junction. Its most common clinical presentation is represented by upper gastrointestinal bleeding and esophagogastroduodenoscopy is the main diagnostic tool. Among the etiopathogenetic and multiple predisposing factors described are hypovolemia, shock state, ischemia, congestive heart failure, acute renal failure, infections, trauma, and diabetes mellitus. Current management of this condition consists of treating the underlying pathology, nil per os, and antacid administration in uncomplicated cases. Although most of the cases have favorable prognosis, complications such as pneumomediastinum or esophageal stricture may occur and fatal cases are a consequence of underlying comorbidities.

A rare cause of acute esophageal necrosis: A case report

“…AEN is a rare medical disorder characterized by diffuse, circumferential, black mucosal pigmentation of the esophagus found on gastroscopy with an abrupt transition to normal mucosa [1] . The prevalence of this rare disease varies between 0.06 and 0.28% in the literature [2] . It is more frequent in elderly men with comorbidities such as diabetes mellitus, hypertension, kidney disease, alcoholism, malnutrition, and cardiovascular diseases [2] .…”

“…The prevalence of this rare disease varies between 0.06 and 0.28% in the literature [2] . It is more frequent in elderly men with comorbidities such as diabetes mellitus, hypertension, kidney disease, alcoholism, malnutrition, and cardiovascular diseases [2] .…”

“…Empiric antibiotics should be initiated when esophageal perforation and unexplained fevers are suspected in immunocompromised patients [ 4 ]. Following the results of esophageal cultures and biopsy specimens; specific antimicrobial therapy should be adapted [2] . Surgical intervention in patients with AEN is reserved for perforated esophagus with resultant mediastinitis and abscess formation [8] .…”

Into the dark of the black oesophagus

“…Despite the poor prognosis of AEN, most patients present with endoscopic improvement within a short time, from 7 days to 1 month [27,62]. Although there are no clinical guidelines in AEN management, it seems reasonable to perform a repeat endoscopy 1 month after initial presentation [9,69].…”