Comprehensive review of acute oesophageal necrosis

Abstract

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.

Acute Esophageal Necrosis in a Septic Patient with a History of Cardiovascular Disease

“…We propose that the extensive comorbid vascular disease present in our patient, especially the previous surgical treatment of AAA, resulted in ischemic necrosis of the distal esophagus consequent to limited hypotensive stress. e distal esophagus is normally perfused via the esophageal branch of the left gastric artery arising from the celiac trunk [1]. Although computed tomography angiography was not performed in our patient, esophageal vasculature supply proximal to the celiac trunk was also likely not well collateralized at baseline given the patient's vasculopathic manifestations elsewhere (coronary artery disease and chronic kidney disease).…”

“…Acute esophageal necrosis (AEN) is rare with less than one hundred patient cases published in the literature and a prevalence of 0.2% [1]. Typically, AEN presents in critically ill patients with hemodynamic compromise such as cardiovascular disease or sepsis requiring intensive inotropic support [2].…”

“…e distal esophagus is most often involved in AEN, likely due to its decreased vascular supply in the face of a global hypoperfused state and vasoconstriction. A "two-hit" hypothesis theory has developed suggesting hypoperfusion increases opportunity for injury to the mucosa by a second entity such as toxins or acids that results in rapid onset of necrosis unless addressed and treated [1]. erefore, a high level of suspicion for acute esophageal necrosis as a differential diagnosis for gastrointestinal bleed is imperative among patients with cardiovascular disease and sepsis given its high mortality rate of 32% and potential rapidity of onset requiring urgent treatment [1].…”

A Case of Black Esophagus

“…Nonetheless, many experts believe that the reported incidence underestimate the true incidence of this condition due to the transient nature and spontaneous resolution of this condition. Previous reports showed that it is more common in geriatric males, with a male-to-female ratio of 2.3:1 [3]. Although it can involve variable lengths of the esophagus, the distal part is the most commonly affected [4].…”

Gurvitis syndrome: the dark shade of hematemesis

“…His condition did not improve, with acute liver failure and severe coagulopathy (international normalized ratio 6.8), worsened neurological status, hypoglycemia, and finally death by cardiorespiratory arrest after 4 days. Mortality rate is high (30 % -50 %) and related to severe co-morbidities, as the death rate due to AEN is only 6 % [3,4].…”