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 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: 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.

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.

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 associated with gastric volvulus

2000 ◽  
Vol 51 (5) ◽  
pp. 0610-0612 ◽  
Author(s):  
Stavros R. Katsoulis ◽  
Michael R. Kram ◽  
Lyall R. Gorenstein ◽  
David R. Eisen
Keyword(s):  
Gastric Volvulus ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis

“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

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 Forsaken Foregut: Case Report of Simultaneous Black Esophagus and Ischemic Cholangiopathy

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Paul A. Cameron ◽  
Franzjosef Schweiger
Keyword(s):  
Biliary Tree ◽  
Low Flow ◽  
Esophageal Injury ◽  
Contributing Factors ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Hemodynamic Compromise ◽  
Black Esophagus ◽  
First Case ◽  
Ischemic Cholangiopathy

Black esophagus or acute esophageal necrosis rarely occurs after severe hemodynamic compromise or low-flow states. Other contributing factors may include corrosive injury from gastric contents and diminished mucosal repair mechanisms. Ischemic cholangitis, another rare clinical entity, is also usually the result of a significant vascular and/or hypotensive insult to the biliary tree. We describe the first case of combined acute esophageal necrosis and ischemic cholangiopathy in a 62-year-old male who completely recovered from the esophageal injury but developed progressive liver failure from ischemic cholangiopathy.

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