Acute esophageal necrosis and low-flow state.

Acute esophageal necrosis (AEN), also called black esophagus, is quite exceptional. Endoscopic findings show circumferential black discolouration of the esophagus with or without exudates. The etiology of AEN is presently unknown and is assumed to be multifactorial. Distal esophageal involvement with proximal extension ending sharply at the gastroesophageal junction is the most common presentation. The present case report describes the clinical and endoscopic evolution of black esophagus observed in a patient with significant peripheral vascular disease, who was presented to the intensive care unit at the Hopital Saint-Francois d'Assise (Quebec City, Quebec). Through an extensive review of the literature, common underlying clinical conditions of patients diagnosed with AEN have been identified.     

Acute esophageal necrosis: a rare syndrome

Background Acute esophageal necrosis, which presents as a black esophagus on endoscopy, is a rare disorder that is poorly described in the medical literature. In this study, we analyze all cases reported to date to define risk factors, clinical presentation, endoscopic features, histologic appearance, treatment, complications, outcome and etiopathogenesis of the disease and to describe a distinct medical syndrome and propose a staging system. Methods We searched Medline and PubMed from January 1965 to February 2006 for English-language articles using the key words “acute esophageal necrosis,” “necrotizing esophagitis,” and “black esophagus.” Results A total of 88 patients were reported in the literature during the 40 years, 70 men and 16 women with an average age of 67 years. Patients were generally admitted for gastrointestinal bleeding and cardiovascular event/shock. Patients presented with hematemesis and melena in more than 70% of the cases. Upper endoscopy showed black, diffusely necrotic esophageal mucosa predominantly affecting the distal third of the organ. Necrosis was confirmed histologically in most cases. Complications included strictures or stenoses, mediastinitis/abscesses, and perforations. Overall mortality was 31.8%. Conclusions This study provides a structured approach to identifying risk factors, diagnosis, and pathogenesis of the acute esophageal necrosis. Risk factors include age, male sex, cardiovascular disease, hemodynamic compromise, gastric outlet obstruction, alcohol ingestion, malnutrition, diabetes, renal insufficiency, hypoxemia, hypercoagulable state, and trauma. Mechanism of damage is usually multifactorial secondary to ischemic compromise, acute gastric outlet obstruction, and malnutrition. Overall, acute esophageal necrosis should be viewed as a poor prognostic factor, associated with high mortality from the underlying clinical disease.     

Acute esophageal necrosis caused by alcohol abuse

Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.     

Black esophagus: Acute esophageal necrosis syndrome

Acute esophageal necrosis (AEN), commonly referred to as "black esophagus", is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusi...     

Acute esophageal necrosis after kidney transplantation: A case report

Rationale:Acute esophageal necrosis (AEN) is a rare syndrome with characteristic endoscopic and pathologic findings. It usually results from a combination of tissue hypoperfusion, impaired local defense barriers, and massive reflux of gastric contents. We report a case of AEN after a kidney transplant.Patient concerns:A 53-year-old man with hypertension and end-stage renal disease presented with abdominal pain and a single episode of hematemesis 14 days after kidney transplantation.Diagnosis:Upper endoscopy revealed circumferential black coloration in the mid to lower esophageal mucosa. Esophageal biopsy showed ulcer, and immunostains were negative for viral etiology.Interventions:Conservative management was done with total parenteral nutrition and proton pump inhibitor.Outcomes:The patient experienced no further episodes of hematemesis or abdominal pain and follow-up endoscopy showed remarkable changes from the black mucosa to a red friable mucosa with whitish exudates.Lessons:In the case, AEN occurred in the setting of normal blood pressure after major surgery despite the absence of preceding factors such as hypotension and infections. The possibility of AEN should be considered in patients with solid organ transplantation who present with abdominal pain, dysphagia, and hematemesis.     

Acute esophageal necrosis and liver pathology, a rare combination

Acute esophageal necrosis (AEN) or “black esophagus“ is a clinical condition found at endoscopy. It is a rare entity the exact etiology of which remains unknown. We describe a case of ‘black esophagus‘, first of its kind, in the setting of liver cirrhosis and hepatic encephalopathy.     

Acute esophageal necrosis after cellulitis in an obese patient with diabetes mellitus

A 59‐year‐old obese Japanese man with poorly controlled type 2 diabetes mellitus presented with severe heartburn for 3 days after inguinal cellulitis and exacerbated glycemic control, without any signs of upper gastrointestinal bleeding. The patient had a high plasma glucose level (34.0 mmol/L) and was dehydrated. Emergent esophagogastroduodenoscopy showed black discoloration predominantly affecting the lower esophagus; thus, acute esophageal necrosis (AEN) was diagnosed. This black discoloration was not present on esophagogastroduodenoscopy 20 days prior to presentation, and disappeared 6 days after conservative treatment. To conclude, acute esophageal necrosis should be considered if a patient in marked hyperglycemic status presents with unendurable heartburn, even when upper gastrointestinal bleeding is not observed or recent esophagogastroduodenoscopy was unremarkable.     

Acute pancreatic necrosis

Summary and conclusions Thirty-two cases of acute pancreatic necrosis have been reported, including 20 fatal cases, 19 of which had postmortem studies.Alcoholism appeared to be a precipitating factor.Serum amylase determinations were not very helpful, being elevated in only 50 per cent of cases.Transient glycosuria and albuminuria were frequent. Elevated blood sugar occurred in about half of the cases and was a grave prognostic sign especially when associated with normal serum amylase studies.Other grave prognostic signs included old age, history of hypertension and diabetes, and the development of shock and hyperglycemia. The incidence of concurrent gallbladder disease was low.The over-all mortality was 62.5 per cent. All autopsied cases showed pancreatic necrosis, and the majority showed fatty metamorphosis of the liver.     

Acute ruptured esophageal duplication cyst

A 32-year-old man presented acutely with a ruptured esophageal duplication cyst. This is a rare complication from an unusual congenital condition. The case describes his clinical presentation, radiological investigation and surgical management. The pathology of the excised specimen is described and a literature review concludes that complete surgical resection of an esophageal duplication is always recommended, even if the condition is asymptomatic. Conventionally this is achieved via a thoracotomy, however thoracoscopic-assisted excision may have a role.     

Acute esophageal necrosis (black esophagus) in the renal transplant recipient: manifestation of primary cytomegalovirus infection

We report a severe case of cytomegalovirus (CMV) esophagitis in a renal transplant recipient presenting as acute esophageal necrosis (AEN, 'black esophagus'). AEN is an uncommon entity that is a result of mucosal necrosis and has been described only a few times previously. To our knowledge, this is the first report of AEN due to a CMV infection. The disease was manifested by abdominal and epigastric pain, thrombocytopenia, leukopenia, and elevated liver enzymes. Upper endoscopy showed acute esophageal necrosis. Ganciclovir therapy was initiated immediately and resulted in a complete remission of symptoms. We conclude that the possibility of CMV infection should be suspected in any patient presenting with cytopenia, elevated liver enzymes, and epithelial gastrointestinal lesions in the first 6 months after transplantation, and that early viral detection and antiviral therapy can be lifesaving.