Black esophagus: acute esophageal necrosis, clinical case and review of literature

Abstract

Black esophagus is a rare, multifactorial disease. A case of acute black esophagus following pancreatic resection is presented. The patient referred us with a specific gastrointestinal bleeding. An esophagogastroduodenoscopy confirmed the diagnosis. We performed conservative treatment with complete esophageal re-epithelization and negative follow-up for stenosis or necrosis relapse.

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

“…AEN is a rare cause of severe injury to the esophagus [7][8][9][10][11][12][13]. It has an endoscopic appearance characterized by diffuse, circumferential black discoloration of the mucosa that affects the distal esophagus and stops abruptly at the gastroesophageal junction [1][2][3][4][5][6][7]. The etiology of the disease is unclear but thought to be multifactorial owing to the complex relationship between the esophagus' intrinsic mucosal barriers and segmental vascular supply [8][9][10].…”

“…It is hypothesized that due to the smaller caliber of lower segment feeding vessels, corresponding areas of the distal esophagus are predisposed to more ischemic insults and necrosis during hypoperfusion states. A "two-hit" model has been proposed and identifies ischemia as the key player in the manifestations of the disease, with some form of gastric outlet obstruction perpetuating the causative insult of reflex acid and contributing to the breakdown of mucosa [6][7][8][9][10][11][12][13]. A neutrophilic response then ensues as a result of epithelial damage or secondary to infection.…”

“…Poor nutritional status and general deconditioning may also contribute to reduced mucosal buffering and may potentiate the mechanisms by which esophageal necrosis is accelerated [5,[11][12][13]. The diagnosis is achieved by visualizing the blackened segment of the esophagus with biopsies obtained to exclude other etiologies [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Black esophagus affects men more so than women with a peak incidence in the sixth decade of life [2,14].…”

“…Acute esophageal necrosis (AEN), also known as black esophagus or necrotizing esophagitis, is a rare severe disease of the esophagus affecting only the distal esophagus [1][2][3][4][5][6]. The etiology of the disease is thought to be multifactorial [1,[4][5][6][7]. It has been postulated that gastroesophageal acid reflux disrupts the intrinsic mucosal barriers of the esophagus and causes mucosal injury, while the limited blood supply of the distal esophagus can lead to esophageal necrosis when there is hemodynamic instability.…”

“…The prevalence of the disease is reported to be up to 0.2% in autopsy series [1][2][3]. The endoscopic findings are striking with circumferential black discoloration seen only in the distal esophagus [1][2][3][4][5][6][7]. Patients present with signs of upper gastrointestinal bleeding, such as hematemesis or melena.…”