Black esophagus syndrome associated with diabetic ketoacidosis

Rigolon, Riccardo; Fossà, Irene; Rodella, Luca; Targher, Giovanni

doi:10.12998/wjcc.v4.i2.56

Cited by 24 publications

(18 citation statements)

References 4 publications

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“…Of these cases, we managed to extract data from 79 articles having 105 cases of AON (online supplementary table 1). 5–82 Data could not be extracted from (n=13) of the articles containing a total of (n=20) cases 4 83–95. The most common reasons for these were unavailability of complete data or the language being other than English.…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopy reveals black discolouration of the oesophageal mucosa, which is a characteristic finding 5. A biopsy is essential to rule out other causes, such as infection due to Klebsiella pneumoniae , Cytomegalovirus, herpes simplex virus or Candida albicans 10–12. Microscopic analysis shows non-viable epithelium, polymorphonuclear infiltrates, inflammatory changes and necrosis of oesophageal mucosa extending into the deeper parts 13…”

Section: Discussionmentioning

confidence: 99%

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Comprehensive review of acute oesophageal necrosis

Ullah¹,

Mehmood

Micaily

et al. 2019

BMJ Case Rep

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Acute oesophageal necrosis, also known as ‘black oesophagus’, is a rare condition characterised by the black discolouration of the oesophageal mucosa on endoscopy and involves the distal oesophagus in majority of cases but may also extend proximally. A number of conditions are found to be associated with it and it is thought to occur due to a combination of hypovolaemia and inadequate oesophageal protective mucosal barrier function. Gastric secretions may have a direct effect on the oesophageal mucosa. We present a case of a woman who presented with haematemesis and significant hypotension after a session of haemodialysis. Black oesophagus was confirmed on esophagogastroduodenoscopy. She was given two units of packed red blood cells and one unit of platelets, and started on a pantoprazole infusion. However, despite rigorous attempts at resuscitation the patient failed to recover.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comprehensive review of acute oesophageal necrosis

Ullah¹,

Mehmood

Micaily

et al. 2019

BMJ Case Rep

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“…The history of diabetes and the laboratory evidence of DKA should also be addressed, given the known association between acute esophageal necrosis (AEN), and diabetes [ 6 – 8 ]. AEN, also called “black esophagus” because of the endoscopic appearance of the necrotic epithelium, occurs in several critical care situations [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Necrotic mucosa is consistently found circumferentially at the esophago-gastric junction with varying degrees of proximal extension [ 6 , 7 ]. Microscopically, there is necrosis of the mucosa and submucosa with denuded epithelium, necrotic debris and marked acute inflammation [ 8 ]. Proposed pathophysiologic mechanisms include mucosal ischemia, diminished mucosal defenses, and damage from gastric reflux [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy

Mitchell

Petrella

2017

BMC Gastroenterol

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Background“Lichenoid esophagitis” is a descriptive term for a lichenoid pattern of inflammation in the esophagus for which a precise histologic diagnosis cannot be established. The differential diagnosis includes lichen planus, a drug-related reaction, and viral infection. Lichenoid esophagitis causing death has not been reported previously. We describe a case, diagnosed by autopsy, of lichenoid esophagitis in which massive bleeding from generalized epithelial sloughing and a large longitudinal ulcer proved fatal.Case presentationA 52 year-old diabetic woman collapsed at her home in front of an acquaintance. “Bloody vomit” was noted. Despite resuscitation efforts, the patient died. A complete autopsy was performed. The middle portion of the esophagus showed a 9 cm longitudinal ulcer situated 12 cm from the esophago-gastric junction. Microscopic examination showed complete sloughing of the esophageal epithelium with a striking subepithelial lichenoid lymphocytic infiltrate extending into the muscularis mucosae. The findings were considered compatible with lichenoid esophagitis. Laboratory studies also showed the presence of diabetic ketoacidosis.ConclusionsLichenoid esophagitis is an appropriate diagnostic term when clinical, histologic and laboratory findings do not allow for specific categorization of lichenoid inflammation in the esophagus. As illustrated here for the first time, lichenoid esophagitis may cause ulceration and mucosal sloughing severe enough to result in massive upper gastrointestinal bleeding and death. Translating these autopsy findings to the clinical setting, it is possible that the endoscopic finding of a longitudinal mid-esophageal ulcer in the presence of proximal stricture may be indicative of underlying lichenoid esophagitis.

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“…According to the "two hit" hypothesis, there is an initial event (ie, low flow vascular state), which then predisposes the esophageal mucosa to a severe topical injury (ie, by reflux of acid and pepsin). Risk factors include vasculopathy, heart failure, hypovolemic shock, diabetic ketoacidosis, aortic dissection, alcohol intoxication, thromboembolic events, an underlying malignancy, peptic ulcus, gastric outlet obstruction, malnutrition, esophageal trauma and infections (ie, Candida albicans, cytomegalovirus, herpes virus, and Klebsiella pneumoniae) [6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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

Raquel¹,

Garzón²,

María³

et al. 2020

COR

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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.

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Black esophagus syndrome associated with diabetic ketoacidosis

Cited by 24 publications

References 4 publications

Comprehensive review of acute oesophageal necrosis

Comprehensive review of acute oesophageal necrosis

Lichenoid esophagitis presenting as fatal upper gastrointestinal bleeding in a 52 year-old woman: a case diagnosed by autopsy

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

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