Esófago negro asociado a estado de choque. A propósito de un caso / Black esophagus associated with shock. About a case

Resumen La necrosis esofágica aguda, también conocida como esófago negro, es una patología poco común que se diagnostica mediante endoscopia en la que se muestra una mucosa esofágica de aspecto negro. Su causa es desconocida, pero se le atribuye un origen multifactorial. Debe considerarse una lesión esofágica de origen isquémico. Se presenta el caso de un paciente de 56 años con síntomas respiratorios sugestivos de proceso infeccioso grave, con un cuadro clínico rápidamente progresivo y requerimiento de aseguramiento de la vía aérea, soporte vasopresor y orgánico multimodal, estudio endoscópico por clínica de hemorragias de vías digestivas altas con evidencia de lesiones compatibles con necrosis esofágica aguda. A pesar de manejo multimodal en unidad de cuidados intensivos el paciente fallece al día 34 desde su ingreso hospitalario.

Abstract Acute esophageal necrosis, also known as the black esophagus, is a rare pathology diagnosed by endoscopy that shows a black-looking esophageal mucosa. Its cause is unknown, but a multifactorial origin is attributed to it. An esophageal lesion of ischemic origin should be considered. We present the case of a 56-year-old patient with respiratory symptoms suggestive of a severe infectious process, with a rapidly progressive clinical picture and requirement of airway security, multimodal vasopressor, and organic support, and an endoscopic study due to clinical symptoms of upper digestive tract bleeding with evidence of lesions compatible with acute esophageal necrosis. Despite multimodal management in the intensive care unit, the patient died 34 days after hospital admission.

The dark side of the esophagus

Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.

The dark side of the esophagus

Acute esophageal necrosis (AEN), also known as "black esophagus," is an entity characterized by the circumferential black appearance of esophageal mucosa, usually associated with hypoperfusion and gastric outlet obstruction. This entity has a reported prevalence of up to 0.2%, affecting predominantly elderly men with multiple comorbidities. Most cases resolve with conservative treatment with no need of surgical intervention. However, the overall prognosis is poor, with mortality reaching one-third of cases due to the patient's underlying illness. In this article we present three cases of patients with AEN.

Esófago negro como causa de hemorragia digestiva alta: reporte de un caso / Black esophagus as a cause of upper gastrointestinal bleeding: a case report

Resumen La esofagitis necrotizante aguda es una entidad poco común que afecta sobre todo a ancianos. La presentación clínica más común es hemorragia digestiva alta. El pronóstico depende de las enfermedades de base con una mortalidad de hasta el 50 %. Se presenta el caso de un varón de 77 años con historia de una semana de melena, 3 episodios de hematemesis y epigastralgia. La endoscopia digestiva alta reveló una mucosa con necrosis en parches y fibrina en el esófago medio y distal. La biopsia de esófago fue compatible con necrosis de mucosa.

Abstract Acute necrotizing esophagitis is a rare entity that affects mainly elderly patients. The most common clinical presentation is upper gastrointestinal bleeding. The prognosis depends on the underlying diseases, with a mortality of up to 50%. This is the case of a 77-year-old male patient who presented with melena, three episodes of hematemesis, and epigastric pain for a week. Upper endoscopy revealed mucosa with spotty necrosis and fibrin in the middle and distal esophagus. Esophageal biopsy was compatible with mucosal necrosis.

Esofagitis necrotizante (esófago negro). Presentación de casos y revisión de la literatura / Necrotizing esophagitis (black esophagus): Presentation of cases and literature review

Resumen La esofagitis necrotizante aguda (esófago negro) es una patología grave poco frecuente, que se caracteriza por presentar pérdida parcial o total del epitelio, con ulceración hasta el esfacelo circunferencial de todas las capas de la mucosa y submucosa. También se evidencia compromiso frecuente de las capas profundas musculares y perforación, con aspecto negruzco al examen endoscópico, que le ha dado su nombre más conocido, el de esófago negro. Se presentan cinco casos ilustrativos concordantes con la descripción de la literatura médica, que luego de ser revisada reportó todos los casos descritos, junto con los factores de riesgo y pronóstico.

Abstract Acute necrotizing esophagitis (black esophagus) is a rare pathology that is characterized by partial or total loss of the epithelium, ulceration up to the circumferential slough of all layers of the mucosa and submucosa, frequent involvement of deep muscle layers, and frequent perforations. Its blackish appearance in endoscopic examinations has given it the name of black esophagus. Five illustrative cases, all concordant with descriptions the medical literature, are presented in this study together with a review of the literature, case descriptions and risk and prognosis factors.

Esôfago negro: relato de 2 casos / Black esophagus: report of two cases

Esôfago negro, também descrito como necrose esofágica aguda, é definido pelo aspecto enegrecido do esôfago observado à endoscopia digestiva alta. A condição é rara, está presente em pacientes gravemente comprometidos, e habitualmente se manifesta por hemorragia digestiva alta. Os principais fatores de risco envolvidos incluem doença cardiovascular, diabetes mellitus, desnutrição, cirrose hepática e insuficiência renal. Apresenta alta morbidade e mortalidade. Relatamos dois casos de esôfago negro associados à cirrose hepática.

Black esophagus, also described as acute esophageal necrosis is defined by blackish aspect of the esophagus seen at endoscopy. The condition is rare, is present in patients severely compromised, and usually manifests as upper gastrointestinal bleeding. The main risk factors involved include cardiovascular disease, diabetes mellitus, malnutrition, liver cirrhosis, e renal failure. It has high morbidity and mortality. We describe two cases of black esophagus associated with liver cirrhosis.

Acute Necrotizing Esophagitis: An Autopsy Case Report and Literature Review / 대한법의학회지

Acute necrotizing esophagitis (AEN), also called "black esophagus," is a rare disorder with an unknown pathogenesis. Endoscopic findings generally show black pigmentation throughout the esophagus. This case also offered rare views of the gross anatomy of this disorder. Histological examination revealed that the mucosal and submucosal layers of the esophagus were involved in the severe necrotizing inflammation. The chief manifestation of this disease is hematemesis from hemorrhage of the upper gastrointestinal tract with a typically multifactorial etiology. AEN is also characterized by a clear boundary at the gastroesophageal junction where the necrosis stops. In this study, we report an autopsy case of a 61-year-old man with necrotizing inflammation throughout the esophagus and esophageal necrosis from the laryngopharynx to the gastroesophageal junction. The patient was a disabled person with a history of alcohol abuse who was also diagnosed with mild coronary arteriosclerosis and fatty liver on the basis of the underlying diseases. In this case, the main etiology for poor perfusion from the distal esophageal area was likely underlying illness, history of alcoholism, and malnutrition.

Acute esophageal necrosis: a case series of five patients presenting with "Black esophagus".

Acute esophageal necrosis (AEN), also known as “Black esophagus”, is a rare condition that typically presents as upper gastrointestinal hemorrhage. A retrospective chart analysis was conducted at two tertiary care hospitals over a three-year period (2005–2007) using a computerized inpatient database. Out of 9,179 upper endoscopies performed, five patients (0.05% prevalence) were found to have black esophagus. Their mean age was 44 years and themost common presentation was upper gastrointestinal bleeding. All five patients had comorbid conditions, most commonly coronary artery disease, diabetes mellitus, and renal insufficiency. Two patients died, but the cause of death was not related to AEN in either. In conclusion, AEN is usually seen in critically ill elderly patients with multiple comorbid conditions, particularly vascular disease, diabetes mellitus and azotemia.

Esofagitis necrotizante aguda: Una entidad inusual / Acute esophageal necrosis: An unusual entity

La esofagitis necrotizante aguda (ENA), también denominada esófago negro, es una rara enfermedad poco descripta en la literatura médica. Describimos el caso de un hombre de 80 años, con hemorragia digestiva alta quien desarrolló un esófago negro luego de un episodio de hipotensión. La necrosis fue confirmada histológicamente. Los pacientes se presentan con hematemesis y melena en más del 70% de los casos. Los hallazgos endoscópicos muestran una coloración negruzca de la mucosa esofágica. El diagnóstico se realiza con endoscopia y confirmación histológica. La mortalidad es alta (más del 50%) aunque relacionada a las enfermedades de base del paciente. Por último, podemos decir que la sospecha es muy importante en el diagnóstico de ENA, particularmente en pacientes ancianos con enfermedades asociadas y evidencia de hemorragia digestiva alta. En este trabajo describimos las características clínicas, endoscópicas e histopatológicas de un paciente con ENA.

Acute esophageal necrosis (AEN), also designated black esophagus, is a rare disorder that is poorly described in the medical literature. We present the case of an 80 years old man, with upper gastrointestinal bleeding who developed a black esophagus after hypotensive episodes. Necrosis was confirmed histologically. Hematemesis and melena are present in more than 70% of the cases. Endoscopic findings show black discoloration of the distal esophagus with proximal extension ending sharply at the gastroesophageal junction. Diagnosis is reached endoscopically with histological support. Mortality is high (up to 50%) even though related to the patient's underlying condition. Finally, we may say that to keep in mind the posibility of AEN is a key factor in its diagnosis, particularly in older patients with associated morbidity and evidence of upper gastrointestinal bleeding. In the present report we describe the clinical, endoscopic and histophatological characteristics of a patient with a diagnosis of AEN.

A Case of Acute Esophageal Necrosis with Gastric Outlet Obstruction / 대한소화기학회지

Acute esophageal necrosis (AEN) is a very rare disorder typically presenting as a diffuse black esophageal mucosa on upper endoscopy. For this reason, AEN is often considered to be synonymous with 'black esophagus'. The pathogenesis of entity is still unknown. We report a case of AEN with duodenal ulcer causing partial gastric outlet obstruction. A 53-year-old man presented with hematemesis after repeated vomiting. The upper gastrointestinal endoscopy revealed circumferential black coloration on middle 315 to lower esophageal mucosa that stopped abruptly at the gastroesophageal junction. Pyloric ring deformity and active duodenal ulceration with extensive edema was observed. After conservative management with NPO and intravenous proton pump inhibitor, he showed clinical and endoscopic improvement. He resumed an oral diet on day 7 and was discharged. In our case the main pathogenesis of disease could be accounted for massive esophageal reflux due to transient gastric outlet obstruction by duodenal ulcer and following local ischemic injury.

A Case of Acute Necrotizing Esophagitis / 대한소화기학회지

Acute necrotizing esophagitis, which presents as a black esophagus on endoscopy, is a rare disorder. We report a case of a 48-year-old male with acute necrotizing esophagitis, associated with alcoholic hepatitis. He was admitted to our hospital because of hematemesis. On initial upper esophagogastroduodenoscopy, diffuse friable black colored mucosa at whole length of the esophagus was observed. After conservative treatment with proton-pump inhibitor, esophageal mucosal lesion was healed without complication.

Black Esophagus Associated with Alcohol Abuse

Black esophagus is a rare condition of the esophagus that manifests as endoscopic findings of black-colored esophageal mucosa, which is usually caused by acute esophageal necrosis. We report a case of alcoholic patient who developed black esophagus. The 85-year-old man was admitted to Severance Hospital due to copious hematemesis over 2 days. Upper gastrointestinal endoscopy showed black-colored mucosa in the distal esophagus. Endoscopic biopsies of the esophagus revealed necrotic tissue, without any viable cells. Follow-up upper gastrointestinal endoscopy performed after supportive care with a proton-pump inhibitor, sucralfate, and total parenteral nutrition resulted in the remarkable healing of the esophageal wall with no complications.