SHM Converge Scientific Abstract ePoster Gallery-When the Esophagus Goes Black Case Report of Esophageal Necrosis

Pdf Summary

This case report describes a 59-year-old man with significant comorbidities, including coronary artery disease, multiple sclerosis, COPD, and prior ischemic stroke, who was admitted with septic shock and acute respiratory failure due to pneumonia. He presented with fever, altered mental status, tachycardia, leukocytosis, lactic acidosis, and acute kidney injury. After an episode of coffee-ground vomiting, bedside upper endoscopy revealed acute esophageal necrosis (AEN), also known as “black esophagus.”<br /><br />AEN is a rare but serious condition characterized by circumferential black discoloration and necrosis of the distal esophageal mucosa, typically ending abruptly at the gastroesophageal junction. It is often associated with severe underlying illness, especially sepsis, low blood flow states, diabetes, and other chronic medical problems. The proposed mechanism involves a combination of poor tissue perfusion and increased metabolic demand leading to mucosal injury and necrosis.<br /><br />In this case, intravenous proton pump inhibitor therapy was started, and the patient improved clinically over three days. However, due to his poor functional status, severe disability, and poor prognosis, he chose comfort-focused care.<br /><br />The report emphasizes that AEN may present with upper gastrointestinal bleeding, such as melena or hematemesis, and should be considered in critically ill patients with multiple comorbidities. Early endoscopic evaluation is important for diagnosis. Management is usually conservative, but surgery may be required if complications such as perforation occur.<br /><br />The authors note that AEN remains uncommon, with only a few hundred cases reported since its first description in 1990, and it carries a high mortality rate largely driven by the severity of underlying illness rather than the esophageal lesion itself.

Asset Subtitle

Abdelwahap Elghezewi

Meta Tag

Author List Abdelwahap Elghezewi, Mohamed Hammad, Mustafa Ben Khayal, Wesam Frandah

Category Clinical Vignettes

Concept Acute Esophageal Necrosis

Concept Upper Gastrointestinal Bleeding

Concept Ischemia

Concept Upper Endoscopy

Concept Distal Esophagus

Distinguished Non-Finalist

Presenter Organization Marshall Internal Medicine Residency

Presenting Author Abdelwahap Elghezewi

Track Adult

Keywords

acute esophageal necrosis

black esophagus

septic shock

upper gastrointestinal bleeding

coffee-ground vomiting

pneumonia

endoscopy

esophageal necrosis

proton pump inhibitor

critical illness

Acute Esophageal Necrosis

Upper Gastrointestinal Bleeding

Ischemia

Upper Endoscopy

Distal Esophagus