scholarly journals Acute Esophageal Necrosis Early after Renal Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ahmad Makeen ◽  
Faisal Al-Husayni ◽  
Turki Banamah
Keyword(s):  
Blood Pressure ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Graft Loss ◽  
Low Flow ◽  
Esophageal Mucosa ◽  
Flow State ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Discoloration

Background. Acute esophageal necrosis (AEN) is defined as a diffused black discoloration of the esophageal mucosa involving mainly the distal part of the esophagus. It is considered a rare clinical entity with a high mortality rate. The etiology of AEN is unknown, but it has been correlated to many causes such as malignancies, infections, and hemodynamics instability. Here, we report a case of a patient developing AEN a few days after kidney transplantation. Case Presentation. A 57-year-old male was admitted electively for kidney transplantation that he received from his son. The surgery was complicated with a significant drop in blood pressure but otherwise was uneventful. The patient was showing good signs of recovery but then suffered from significant hematemesis. An urgent upper esophagogastroduodenoscopy revealed black discoloration of the esophageal mucosa in keeping with AEN. The patient was treated with proton pump inhibitors infusion and started empirically on antivirals and antifungals. The patient’s condition improved in regards to the AEN; nonetheless, the complications resulted in graft loss, and the patient returned to hemodialysis. Conclusion. AEN is a critical condition that mandates early intervention. Identifying high-risk populations may aid in early anticipation and diagnosis. Patients with chronic kidney disease are at risk of atherosclerosis leading to a low flow state which is exacerbated during renal transplantation surgery, especially if the procedure was complicated with a drop in blood pressure.

scholarly journals Acute Esophageal Necrosis Secondary to a Paraesophageal Hernia

2021 ◽  
pp. 594-597
Author(s):  
Chris J. Li ◽  
Benjamin B. Claxton ◽  
Peter Block ◽  
Sean Reilly ◽  
Scott Manski ◽  
...  
Keyword(s):  
Paraesophageal Hernia ◽  
Gastric Volvulus ◽  
Gastrointestinal Symptoms ◽  
Antibiotic Use ◽  
Causative Factor ◽  
Low Flow ◽  
Barium Swallow ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis

Acute esophageal necrosis (AEN) or “black esophagus” is a rare clinical entity caused by necrosis of distal esophageal mucosa stemming from esophageal ischemia. Possible etiologies are broad but most commonly include possible triggers of low-flow vascular states in the esophagus, including infections, broad-spectrum antibiotic use, and gastric volvulus, among others. Patients most commonly present clinically with acute onset hematemesis and melena. Here, we describe a patient who initially presented with multiple nonspecific gastrointestinal symptoms, including abdominal pain and nausea, that progressed over a 10-day period, culminating in multiple episodes of hematemesis prior to presentation. Endoscopic evaluation confirmed the diagnosis of AEN and unveiled a possible paraesophageal hernia (PEH) as the causative factor. A subsequent videofluoroscopic barium swallow was utilized to better characterize the upper gastrointestinal anatomy and confirmed the PEH as a likely etiology. Esophagogastroduodenoscopy (EGD) can often identify PEH independently, but in patients with AEN secondary to a possible, but unclear, PEH on EGD, a videofluoroscopic barium swallow is an appropriate and useful next step in confirming the diagnosis. While treatment of AEN traditionally involves fluid resuscitation, intravenous protein pump inhibitors, and total parenteral nutrition, surgical intervention is often indicated in patients who have a contributing and symptomatic PEH.

scholarly journals Acute Esophageal Necrosis and Low-Flow State

2007 ◽  
Vol 21 (4) ◽  
pp. 245-247 ◽  
Author(s):  
Ahmad Burtally ◽  
Philippe Gregoire
Keyword(s):  
Gastroesophageal Junction ◽  
Low Flow ◽  
Quebec City ◽  
Flow State ◽  
Present Case Report ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Proximal Extension ◽  
Clinical Conditions

Acute esophageal necrosis (AEN), also called black esophagus, is quite exceptional. Endoscopic findings show circumferential black discolouration of the esophagus with or without exudates. The etiology of AEN is presently unknown and is assumed to be multifactorial. Distal esophageal involvement with proximal extension ending sharply at the gastroesophageal junction is the most common presentation. The present case report describes the clinical and endoscopic evolution of black esophagus observed in a patient with significant peripheral vascular disease, who was presented to the intensive care unit at the Hopital Saint-Francois d’Assise (Quebec City, Quebec). Through an extensive review of the literature, common underlying clinical conditions of patients diagnosed with AEN have been identified.

“Black Esophagus”: Low Flow State and Acute Esophageal Necrosis

2016 ◽  
Vol 111 ◽  
pp. S805-S806
Author(s):  
Bilal Gondal ◽  
Aaron Miller ◽  
Shu-Yuan Xiao ◽  
Ira Hanan ◽  
Gautham Reddy
Keyword(s):  
Low Flow ◽  
Flow State ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus

scholarly journals Acute Esophageal Necrosis: A View in the Dark

2019 ◽  
Vol 13 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Hafiz Khan ◽  
Moiz Ahmed ◽  
Magda Daoud ◽  
Jobin Philipose ◽  
Saba Ahmed ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Upper Gastrointestinal Bleeding ◽  
Low Flow ◽  
Esophageal Disease ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Upper Gastrointestinal

Acute esophageal necrosis (AEN), also known as Gurvits syndrome, black esophagus, or acute necrotizing esophagitis, is a rare clinical entity and an unusual reason for upper gastrointestinal bleeding. It is typically described in critically ill patients with multiple medical conditions, arising from a combination of ischemic insult to the esophageal mucosa due to low-flow vascular states, corrosive injury caused by reflux of acid and pepsin, and decreased function of the mucosal barrier systems and reparative mechanisms as occurs in malnourished and debilitated physical states. Patients with AEN tend to be older men, as medical comorbidities including vascular disease, diabetes, hypertension, renal insufficiency, cardiac disease, pulmonary disease, stroke, and cirrhosis may be more common. Typically, patients present with upper gastrointestinal bleeding, and hematemesis or melena is seen in up to 90% of cases. Herein we present 3 cases of AEN in critically ill patients. We also provide a review of the literature to highlight what is currently known about this relatively uncommon esophageal disease.

Acute Esophageal Necrosis Following Kidney Transplantation

2018 ◽  
Vol 113 (Supplement) ◽  
pp. S1038
Author(s):  
Alex M. Kesler ◽  
Paul T. Kröner ◽  
Hani M. Wadei
Keyword(s):  
Kidney Transplantation ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis

scholarly journals Pharmacological management of low blood flow state in less than 28weeks neonate.

2021 ◽  
Author(s):  
Femi Adeniyi ◽  
Kunle Oyedokun ◽  
Adeniyi Ajiboye ◽  
Sanjeev Rath
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Pharmacological Treatment ◽  
Superior Vena ◽  
Ductus Arteriosus ◽  
Vena Cava ◽  
Low Flow ◽  
Systemic Resistance ◽  
Preterm Neonates ◽  
Flow State

low blood flow state is defined as insufficient cardiac output to maintain adequate cellular metabolism at the organ level. A low blood flow state can be measured by reduced organ perfusion, such as reduced superior vena cava flow[1,2] or high resistance flow in superior mesenteric doppler scan [3]. The combination of capillary refill time of greater than 4 seconds and serum lactate greater than 4 mmol/litre has 97% sensitivity of identifying low blood flow state [4]. In the presence of the above markers of a low blood flow state, the blood pressure may be normal or high in the first 48hours of life due to high systemic resistance [5]. Therefore, high, or normal blood pressure should be interpreted with great caution. CONCLUSIONThe pharmacological treatment of a low blood flow state should be guided by thorough clinical assessment. The prophylaxis or stress dose hydrocortisone treatment of low flow state is gaining grounds mainly when there is evidence of adrenal insufficiency. The choice and titration of pharmacological treatment should be guided by functional echocardiography. The use of Dobutamine as first-line treatment is advised when myocardia dysfunction on echocardiography is noted.Milrinone use is reserved for extreme preterm neonates with myocardia dysfunction before patent ductus arteriosus ligation. Dopamine and noradrenaline remain the commonly used first and second-line vasopressors, respectively, to manage low blood flow states secondary to poor vasomotor resistance.

scholarly journals Graft function and pregnancy outcomes after kidney transplantation

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Anke Schwarz ◽  
Roland Schmitt ◽  
Gunilla Einecke ◽  
Frieder Keller ◽  
Ulrike Bode ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Pregnancy Outcomes ◽  
Fetal Death ◽  
Graft Loss ◽  
Graft Function ◽  
Trial Registration ◽  
Control Group ◽  
Kaplan Meier ◽  
Egfr Decline

Abstract Background After kidney transplantation, pregnancy and graft function may have a reciprocal interaction. We evaluated the influence of graft function on the course of pregnancy and vice versa. Methods We performed a retrospective observational study of 92 pregnancies beyond the first trimester in 67 women after renal transplantation from 1972 to 2019. Pre-pregnancy eGFR was correlated with outcome parameters; graft function was evaluated by Kaplan Meier analysis. The course of graft function in 28 women who became pregnant after kidney transplantation with an eGFR of < 50 mL/min/1.73m2 was compared to a control group of 79 non-pregnant women after kidney transplantation during a comparable time period and with a matched basal graft function. Results Live births were 90.5% (fetal death n = 9). Maternal complications of pregnancy were preeclampsia 24% (graft loss 1, fetal death 3), graft rejection 5.4% (graft loss 1), hemolytic uremic syndrome 2% (graft loss 1, fetal death 1), maternal hemorrhage 2% (fetal death 1), urinary obstruction 10%, and cesarian section. (76%). Fetal complications were low gestational age (34.44 ± 5.02 weeks) and low birth weight (2322.26 ± 781.98 g). Mean pre-pregnancy eGFR was 59.39 ± 17.62 mL/min/1.73m2 (15% of cases < 40 mL/min/1.73m2). Pre-pregnancy eGFR correlated with gestation week at delivery (R = 0.393, p = 0.01) and with percent eGFR decline during pregnancy (R = 0.243, p = 0.04). Pregnancy-related eGFR decline was inversely correlated with the time from end of pregnancy to chronic graft failure or maternal death (R = -0.47, p = 0.001). Kaplan Meier curves comparing women with pre-pregnancy eGFR of ≥ 50 to < 50 mL/min showed a significantly longer post-pregnancy graft survival in the higher eGFR group (p = 0.04). Women after kidney transplantation who became pregnant with a low eGFR of > 25 to < 50 mL/min/1.73m2 had a marked decline of renal function compared to a matched non-pregnant control group (eGFR decline in percent of basal eGFR 19.34 ± 22.10%, n = 28, versus 2.61 ± 10.95%, n = 79, p < 0.0001). Conclusions After renal transplantation, pre-pregnancy graft function has a key role for pregnancy outcomes and graft function. In women with a low pre-pregnancy eGFR, pregnancy per se has a deleterious influence on graft function. Trial registration Since this was a retrospective observational case series and written consent of the patients was obtained for publication, according to our ethics’ board the analysis was exempt from IRB approval. Clinical Trial Registration was not done. The study protocol was approved by the Ethics Committee of Hannover Medical School, Chairman Prof. Dr. H. D. Troeger, Hannover, December 12, 2015 (IRB No. 2995–2015).

scholarly journals Acute Esophageal Necrosis in a Septic Patient with a History of Cardiovascular Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Michael Coles ◽  
Victoria Madray ◽  
Pearl Uy
Keyword(s):  
Cardiovascular Disease ◽  
Gallstone Pancreatitis ◽  
Esophageal Mucosa ◽  
Upper Endoscopy ◽  
Endoscopic Retrograde ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
History Of ◽  
Gi Bleed

Acute esophageal necrosis (AEN), or colloquially named “black esophagus,” is a rare clinical condition often associated with ischemic injury to the esophagus secondary to splanchnic vasoconstriction during hypotensive episodes. We present a case of a 78-year-old man with extensive cardiovascular disease who was initially admitted for gallstone pancreatitis and possible cholangitis. His hospital course was complicated by possible sepsis secondary to aspiration pneumonia and hematemesis secondary to acute ischemic esophageal necrosis as noted on upper endoscopy. Interestingly, the patient only had a transient episode of hypotension (approximately 35 minutes) not requiring vasopressor support, which improved with fluid resuscitation, and endoscopic retrograde cholangiopancreatography (ERCP) done 3 days prior showed normal esophageal mucosa. Clinicians should be aware of the possibility of acute esophageal necrosis as a potential etiology of gastrointestinal (GI) bleed in patients with cardiovascular disease and sepsis.

Acute Esophageal Necrosis (Black Esophagus): An Autopsy Case Series

2021 ◽  
Vol 11 (3) ◽  
pp. 115-125
Author(s):  
Lauren R. Crowson-Hindman ◽  
Keenen Smith ◽  
Angelina Phillips
Keyword(s):  
Gastroesophageal Junction ◽  
Case Series ◽  
Background Information ◽  
Unknown Etiology ◽  
Pathologic Finding ◽  
Esophageal Mucosa ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Acute Necrotizing

Introduction: Acute esophageal necrosis (AEN), also known as black esophagus and acute necrotizing esophagitis, is a rare pathologic finding of unknown etiology. It was first characterized as diffuse, circumferential black discoloration of the esophageal mucosa that affects predominantly the distal esophagus with sharp transition to normal-appearing mucosa at the gastroesophageal junction. Case frequency of AEN remains low and mainly found incidentally, with up to 0.2% in autopsy and endoscopy studies. Men are 4 times more commonly affected and overall mortality is approximately 32%. Methods: Black esophagus was incidentally found during ten forensic autopsy cases. Complete autopsies with photographs, histological examination, and toxicological analysis were performed. Case background information was reviewed. A review of literature was done, with research criteria including previous case reports, diagnosis, and autopsy, endoscopic, and microscopic findings of AEN. Results: Nine of ten deceased were male, with an age range of 26 to 67 years old. The most common preexisting pathological condition was chronic alcohol consumption, seen in six of ten cases, and in eight cases, the death occurred suddenly at home. “Classic” black esophagus was only seen in four cases. Upper gastrointestinal hemorrhage due to acute necrotizing esophagitis was established as the immediate cause of death in six of ten cases. Discussion: This case series demonstrates ten cases of AEN with variation in appearance, yet diagnosis supported by histology, ancillary testing, and case information. The case frequency was higher than previously reported, 0.7%, suggesting that the prevalence of AEN may be underestimated, especially in forensic death investigations.

scholarly journals Black Esophagus in the Setting of Diabetic Ketoacidosis: A Rare Finding from Our Institution

2019 ◽  
Vol 13 (3) ◽  
pp. 475-480
Author(s):  
Sara Ghoneim ◽  
Aun Shah ◽  
Shaman Dalal ◽  
Marc Landsman ◽  
Annette Kyprianou
Keyword(s):  
Diabetic Ketoacidosis ◽  
Case Series ◽  
Acid Reflux ◽  
Esophageal Mucosa ◽  
Upper Endoscopy ◽  
Acute Esophageal Necrosis ◽  
Rare Finding ◽  
Black Esophagus ◽  
Autopsy Series ◽  
Black Discoloration

Acute esophageal necrosis (AEN) is defined as necrosis of the esophageal mucosa seen as diffuse black discoloration of the distal esophagus on an upper endoscopy. The prevalence of the disease is rare and reported to be up to 0.2% in autopsy series. The etiology of the disease is thought to be multifactorial and due to ischemic insults to the esophagus with gastric acid reflux further damaging the vulnerable mucosa. Patients are often critically ill or with significant comorbidities. Here, we present a case series of 3 patients with AEN induced by diabetic ketoacidosis.

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