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

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This case describes acute esophageal necrosis (AEN), also known as “black esophagus,” in a 73-year-old woman with multiple risk factors including diabetes, chronic kidney disease, prior pulmonary embolus, hypertension, hyperlipidemia, and hiatal hernia. She presented with two days of acute epigastric pain, nausea, non-bloody vomiting, diarrhea, dysphagia, odynophagia, and inability to tolerate oral intake. Initial labs showed hyperglycemia, mild liver enzyme elevation, and slightly elevated lactate, while other workup was largely unremarkable.<br /><br />During hospitalization for supportive care, she developed melena with a hemoglobin drop and leukocytosis. Apixaban was stopped and IV pantoprazole started. Esophagogastroduodenoscopy (EGD) revealed 16 cm of circumferential necrotic esophagitis in the middle and lower esophagus, consistent with AEN. Biopsy showed inflammatory necrotic tissue with granulation tissue, supporting the diagnosis. The cause of her AEN was not clearly identified. She was discharged on pantoprazole, and follow-up EGD one month later showed mucosal sloughing consistent with healing ischemic esophagitis.<br /><br />Two months after discharge, she continued to have dysphagia and odynophagia. Repeat EGD showed benign-appearing severe stenosis in the middle and lower esophagus, and a gastric tube was placed to divert contents and allow healing.<br /><br />The report emphasizes that AEN is rare but serious, with a prevalence of only 0.01–0.02% of EGDs. It is typically caused by a combination of ischemia, impaired mucosal defenses, and reflux injury. Management is mainly supportive: IV fluids, hemodynamic stabilization, NPO status, and IV proton pump inhibitors, while also treating underlying causes. Complications include perforation, mediastinitis, and strictures. Mortality is high, largely due to comorbid illness rather than the esophageal injury itself.

Asset Subtitle

Nelly Bellamy

Meta Tag

Author List Brandon Glover, Evan Raff, Lissa Neira, Nelly Bellamy, Nicholas Piazza

Category Clinical Vignettes

Concept Acute Esophageal Necrosis

Concept Endoscopy

Concept Ischemia

Concept Clinical Presentation

Concept Risk Factors

Distinguished Non-Finalist

Presenter Organization University of North Carolina at Chapel Hill

Presenting Author Nelly Bellamy

Track Adult

Keywords

acute esophageal necrosis

black esophagus

dysphagia

odynophagia

melena

esophagogastroduodenoscopy

ischemic esophagitis

proton pump inhibitor

esophageal stricture

supportive care

Acute Esophageal Necrosis

Endoscopy

Ischemia

Clinical Presentation

Risk Factors