Forsaken Foregut: Case Report of Simultaneous Black Esophagus and Ischemic Cholangiopathy

Cameron, Paul A.; Schweiger, Franzjosef

doi:10.1155/2017/8362613

Cited by 7 publications

(12 citation statements)

References 20 publications

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“…The role of ischemia is supported by the observation that this disease may occur in combination with other ischemic events that affect the splanchnic circulation, such as ischemic cholangiopathy [12] or hypoxic hepatitis [13], which also result from generalized states of hypoperfusion in patients with similar risk factors for advanced atherosclerosis. Accordingly, the low incidence of this disease compared with other ischemic events (for example, acute coronary syndrome) among susceptible patients could be related to the complex anastomotic vascular network present in the esophageal submucosa.…”

Section: Pathophysiologymentioning

confidence: 99%

Diagnosis and management of acute esophageal necrosis

Dias

Santos-Antunes

Macedo

2019

aog

113

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Acute esophageal necrosis is a rare syndrome classically characterized by a striking endoscopic image of diffuse and circumferential black mucosal discoloration of distal esophagus, with an abrupt transition at the gastroesophageal junction and variable proximal extension. The typical patient is an older male with general debilitation and multiple comorbidities presenting with hematemesis or melena. The pathophysiology usually involves a combination of esophageal ischemia, backflow injury from gastric chemical contents and impaired mucosal reparative mechanisms associated with debilitated physical states. It may arise in the setting of hemodynamic compromise, diabetic ketoacidosis, hypothermia, alcoholic intoxication, trauma, inflammatory diseases, esophageal local infection, solid organ transplantation, postoperative status, drugs or acute gastric outlet obstruction, usually in the background of a chronic debilitating process, where the concurrent presence of multiple risk factors, including diabetes mellitus, hypertension, malnutrition, malignancy or alcohol abuse, places a patient at higher risk. The characteristic endoscopic appearance establishes the diagnosis. Biopsy is supportive but not required. Management is mainly supportive and consists of correcting coexisting conditions, fluid therapy, bowel rest, intravenous proton pump inhibitor therapy and red blood cell transfusion as needed. Although this is a serious life-threatening condition, appropriate treatment may result in a favorable outcome in the majority of patients.

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Section: Pathophysiologymentioning

confidence: 99%

Diagnosis and management of acute esophageal necrosis

Dias

Santos-Antunes

Macedo

2019

aog

113

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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%

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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“…[8][9][10][11][12][13][14][15][16] These case studies suggested low systemic perfusion due to alcoholic lactic acidosis, hypothermia, and impaired mucosal defence are major pathological causes of alcohol-induced AEN. [8][9][10][11][12][13][14][15][16] Multiple forensic studies on alcohol-induced AEN have shown hemorrhagic shock resulting from esophageal necrosis is the most common cause of death, followed by cardiac arrest and hypothermia (table 2). [17][18][19][20][21] On autopsy, a black pigmentation involving the distal esophagus with or without Wischnewski lesions (red brownish erosions of the mucosa) and hemorrhagic fluid collection are commonly reported findings related to alcohol-induced AEN (table 2).…”

Section: Pathogenesis and Etiologymentioning

confidence: 94%

“…AEN associated with active alcohol drinking is a rare entity, and only nine cases have been reported in the current literature (table 1). [8][9][10][11][12][13][14][15][16] Upper gastrointestinal hemorrhage, vomiting, abdominal pain and unresponsiveness are common presenting symptoms in these cases with AEN associated with drinking alcohol ranging 2-8 pints daily. [8][9][10][11][12][13][14][15][16] These case studies suggested low systemic perfusion due to alcoholic lactic acidosis, hypothermia, and impaired mucosal defence are major pathological causes of alcohol-induced AEN.…”

Section: Pathogenesis and Etiologymentioning

confidence: 99%

“…[8][9][10][11][12][13][14][15][16] Upper gastrointestinal hemorrhage, vomiting, abdominal pain and unresponsiveness are common presenting symptoms in these cases with AEN associated with drinking alcohol ranging 2-8 pints daily. [8][9][10][11][12][13][14][15][16] These case studies suggested low systemic perfusion due to alcoholic lactic acidosis, hypothermia, and impaired mucosal defence are major pathological causes of alcohol-induced AEN. [8][9][10][11][12][13][14][15][16] Multiple forensic studies on alcohol-induced AEN have shown hemorrhagic shock resulting from esophageal necrosis is the most common cause of death, followed by cardiac arrest and hypothermia (table 2).…”

Section: Pathogenesis and Etiologymentioning

confidence: 99%

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Black esophagus: a syndrome of acute esophageal necrosis associated with active alcohol drinking

Siddiqi

Chaudhary

Naqvi

et al. 2020

BMJ Open Gastroenterol

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Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival.

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Forsaken Foregut: Case Report of Simultaneous Black Esophagus and Ischemic Cholangiopathy

Cited by 7 publications

References 20 publications

Diagnosis and management of acute esophageal necrosis

Diagnosis and management of acute esophageal necrosis

Comprehensive review of acute oesophageal necrosis

Black esophagus: a syndrome of acute esophageal necrosis associated with active alcohol drinking

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