SHM Converge Scientific Abstract ePoster Gallery-Black Esophagus: A Case of Acute Esophageal Necrosis

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This case describes a 60-year-old man with one day of bloody vomiting, dysphagia, and odynophagia in the setting of heavy alcohol use (6–8 vodka drinks daily). On exam, he was tachycardic, had mild epigastric tenderness, and was unable to swallow secretions. Labs showed an anion gap metabolic acidosis with elevated beta-hydroxybutyrate, ketonuria, and elevated lactate, consistent with alcoholic ketoacidosis and dehydration.<br /><br />Upper endoscopy with biopsy confirmed acute esophageal necrosis, also known as “black esophagus,” characterized by diffuse esophagitis with a dusky black distal esophagus. CT imaging showed severe esophageal edema without perforation.<br /><br />The presumed cause was a combination of ischemic injury from hypoperfusion due to volume depletion and vomiting, plus direct mucosal injury from refluxed gastric contents in the setting of severe ketoacidosis. The distal esophagus is typically affected most because of relatively weaker blood supply and greater acid exposure.<br /><br />Treatment was supportive, including intravenous fluids, electrolyte replacement, and a proton pump inhibitor. The patient improved gradually, and his diet was advanced over three days.<br /><br />Acute esophageal necrosis is rare but serious. Complications can include perforation and stricture, and overall mortality may exceed 30%, usually due to underlying illness rather than the esophageal injury itself.

Asset Subtitle

Victoria Kalinoski-DuBose

Meta Tag

Author List Bibek Saha, Connor Loftus, Jordan Voss, Victoria Kalinoski-DuBose

Category Clinical Vignettes

Concept Acute Esophageal Necrosis

Concept Endoscopy

Concept Hypoperfusion

Concept Fluid Resuscitation

Concept Esophageal Mucosa

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester

Presenting Author Victoria Kalinoski-DuBose

Track Adult

Keywords

acute esophageal necrosis

black esophagus

alcoholic ketoacidosis

upper gastrointestinal bleeding

dysphagia

odynophagia

esophageal ischemia

proton pump inhibitor

esophageal edema

heavy alcohol use

Acute Esophageal Necrosis

Endoscopy

Hypoperfusion

Fluid Resuscitation

Esophageal Mucosa