SHM Converge Scientific Abstract ePoster Gallery-Acute Esophageal Necrosis: A Rare Complication of Dka

Pdf Summary

This case report describes acute esophageal necrosis (AEN), or “black esophagus,” as a rare but serious complication of diabetic ketoacidosis (DKA). AEN typically appears endoscopically as black, necrotic mucosa in the distal esophagus, sometimes extending proximally. It is associated with ischemia, poor mucosal defense, and low-flow states such as hypovolemia in DKA. Patients may present with upper gastrointestinal bleeding, leukocytosis, and anemia. Diagnosis is confirmed by endoscopy, and management focuses on proton pump inhibitor therapy, bowel rest, avoiding nasogastric tube placement, and close monitoring for complications such as perforation, mediastinitis, stricture, and stenosis.  <br /><br />The reported patient was a 55-year-old man with poorly controlled type 2 diabetes, recurrent DKA, peripheral vascular disease, autonomic neuropathy, chronic hypotension, and heart failure. He initially presented with chest pain and tested positive for SARS-CoV-2, then returned with nausea and vomiting and was treated for gastritis. He was later admitted with severe encephalopathy, DKA, and melena after stopping insulin because of ongoing gastrointestinal symptoms. Although his DKA resolved quickly with fluids and insulin, he continued to have melena. Endoscopy revealed diffuse black discoloration and sloughing of the entire esophagus, consistent with ischemic necrosis.  <br /><br />The report emphasizes that signs of upper GI bleeding in a patient with DKA should raise concern for AEN. Early recognition is important because the condition carries significant morbidity and mortality, and follow-up endoscopy may be needed to document healing and identify long-term complications.

Asset Subtitle

Justin M. Joseph

Meta Tag

Author List David J. Goldstein, Justin M. Joseph

Category Clinical Vignettes

Concept Acute Esophageal Necrosis

Concept Diabetic Ketoacidosis

Concept Upper Gastrointestinal Bleeding

Concept Ischemic Injury

Concept Melena

Distinguished Non-Finalist

Presenter Organization University of New Mexico

Presenting Author Justin M. Joseph

Track Adult

Keywords

acute esophageal necrosis

black esophagus

diabetic ketoacidosis

upper gastrointestinal bleeding

endoscopy

ischemic necrosis

melena

proton pump inhibitor therapy

esophageal perforation

diabetes mellitus

Acute Esophageal Necrosis

Diabetic Ketoacidosis

Upper Gastrointestinal Bleeding

Ischemic Injury

Melena