Ibrahim Haddad, MD1, Bara El Kurdi, MD1, Sumbal Babar, MBBS1, Mahmoud El Iskandarani, MD1, Laith Al Momani, MD1, Mohammad Alomari, MD2, Mark Young, MD1
1East Tennessee State University, Johnson City, TN; 2Cleveland Clinic Foundation, Cleveland, OH
Introduction: Acute esophageal necrosis (AEN), commonly known as "black esophagus", is a rare clinical diagnosis that was described for the first time in 1990 by Goldenberg. Since its first description, less than 100 documented cases were found in the literature. We present a 47 years old female who had this rare lethal condition.
Case Description/Methods: A 47-years-old female with a past medical history significant for alcohol use disorder, gastroesophageal reflux disease, and severe malnutrition, who presented with hematemesis that started after multiple episodes of induced vomiting aiming to detoxify her body from recent heavy drinking according to the patient. At presentation, the patient was in hypovolemic shock and was given normal saline boluses, intravenous omeprazole and admitted to the intensive care unit. Complete blood count showed a drop in her hemoglobin level form her baseline 9 mg/dl to 4.6 mg/dl and was transfused with two units of packed red blood cells. After clinical stabilization, urgent esophagiogastrodudenoscopy (EGD) was done and showed severe esophageal ulcerations, erosions, and necrosis, findings suggestive of acute esophageal necrosis (Figure 1) and active diffuse gastric bleeding. Patient’s hemoglobin dropped again to 4 mg/dl, upon which she received a massive transfusion, was intubated for airway protection and started on vasopressors for hypovolemic shock unresponsive to intravenous fluid. After 4 days patient’s blood pressure normalized, her hemoglobin level stabilized and was extubated successfully. The patient was discharged home on a proton pump inhibitor and sucralfate. EGD was repeated after 2 weeks from discharge (Figure 2) and showed significant improvement of the mucosal abnormalities compared to her initial EGD.
Discussion: AEN is a rare but potentially lethal condition that is believed to be multifactorial in origin with a combination of ischemic insult, corrosive injury from gastric contents and decreased the function of the mucosal barrier, all of them play a major role in its pathogenesis. The mortality rate ranges from 30% to 50% and it’s largely influenced by the severity of the coexisting medical problems. Complications might be acute such as bleeding, mediastinitis, and perforation or chronic such as strictures formation and stenosis. The management is focused mainly on treating the underlying conditions, improving blood supply and acid suppression.
Citation: Ibrahim Haddad, MD; Bara El Kurdi, MD; Sumbal Babar, MBBS; Mahmoud El Iskandarani, MD; Laith Al Momani, MD; Mohammad Alomari, MD; Mark Young, MD. P0387 - A CASE OF BLACK ESOPHAGUS. Program No. P0387. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.