Black esophagus: a case report

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Published Sep 3, 2018
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Vol. 96 No. 2 (2018): Issue Feb 2018

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Mohamed Hichem Loghmari
Wafa Ben Mansour
Arwa Guediche
Wided Bouhlel
Mourad Gahbiche
Leila Safer

Abstract

Introduction:
Acute esophageal necrosis, also known as black esophagus, is a rare digestive complication, frequently manifested by an upper gastrointestinal hemorrhage and occurs in patients with comorbidities.
Aim: To report the case of a patient with a black esophagus revealed by an upper gastrointestinal hemorrhage.
Observation:
A 72-year-old patient with a history of diabetes mellitus, hypertension and ischemic heart disease was hospitalized in surgical intensive care unit for hemorrhagic shock induced by cholecystectomy. On the 7th postoperative day, the patient developed acute hematemesis. Gastroscopy showed circumferential necrosis, localized in the middle and lower third of the esophagus and stopped abruptly at the gastroesophageal junction. Gastric mucosa was strictly normal. The bulb and the first part of duodenum showed multiple superficial ulcers without signs of recent hemorrhage. The patient was placed on absolute diet and total parenteral nutrition associated with high-dose intravenous proton pump inhibitor. Second-look gastroscopy, performed six days later, showed a significant improvement in esophageal lesions. The evolution was marked by the occurrence of pneumonia complicated by septic shock which caused patient's death.
Conclusion:
Black esophagus is a rare pathology of multifactorial etiology. Treatment is based on proton pump inhibitors in combination with resuscitation measures to control comorbidities. Mortality remains high due to the seriousness of comorbid disease states often associated with this condition.

Keywords:

Black esophagus, acute oesophageal necrosis, upper gastrointestinal hemorrhage, endoscopy.

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References

  1. Sako A, Kitayama J, Inoue T, Kaizaki S, Nagawa H, Suzuki H. Black esophagus-cause? Gut 2005; 54: 192, 227.
  2. Gurvits GE, Shapsis A, Lau N, Gualtieri N, Robilotti JG. Acute esophageal necrosis: a rare syndrome. J Gastroenterol 2007; 42: 29-38.
  3. Ben Soussan E, Savoye G, Hochain P, Hervé S, Antonietti M, Lemoine F, Ducrotté P. Acute esophageal necrosis: a 1-year prospective study. Gastrointest Endosc 2002; 56: 213- 217.
  4. Grudell AB, Mueller PS, Viggiano TR. Black esophagus: report of six cases and review of the literature, 1963-2003. Dis Esophagus 2006; 19: 105-110.
  5. Moretó M, Ojembarrena E, Zaballa M, Tánago JG, Ibánez S. Idiopathic acute esophageal necrosis: not necessarily a terminal event. Endoscopy 1993; 25: 534-538.
  6. Augusto F, Fernandes V, Cremers MI, Oliveira AP, Lobato C, Alves AL, Pinho C, de Freitas J. Acute necrotizing esophagitis: a large retrospective case series. Endoscopy 2004; 36: 411-415.
  7. Shafa S, Sharma N, Keshishian J, Dellon ES. The Black Esophagus: A Rare But Deadly Disease. ACG Case Reports Journal 2016; 3 : 88-91.
  8. Trappe R, Pohl H, Forberger A, Schindler R, Reinke P. Acute esophageal necrosis (black esophagus) in the renal transplant recipient: manifestation of primary cytomegalovirus infection. Transpl Infect Dis 2007; 9: 42-45.
  9. Cattan P, Cuillerier E, Cellier C, Carnot F, Landi B, Dusoleil A et al. Black esophagus associated with herpes esophagitis. Gastrointest Endosc 1999; 49: 105-107.
  10. Katsuhara K, Takano S, Yamamoto Y, Ueda S, Nobuhara K, Kiyasu Y. Acute esophageal necrosis after lung cancer surgery. Gen Thorac Cardiovasc Surg 2009; 57: 437-439.
  11. Arthur A. Keresztesi1, Gabriela Asofie2, Laura Chinezu1, Harald Jung1, Acute esophageal necrosis (“black esophagus”): Case series in forensicbautopsies casuistry. Rom J Leg Med 2016; 24: 87-91
  12. Long JD, Orlando RC. Anatomy, histology, embryology, and developmental anomalies of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, editors. Gastrointestinal and liver disease. 8th ed. Philadelphia: Saunders Elsevier 2006; 841-853.
  13. Kim YH, Choi SY. Black esophagus with concomitant candidiasis developed after diabetic ketoacidosis. World J Gastroenterol 2007;13: 5662-5663.
  14. Yasuda H, Yamada M, Endo Y, Inoue K, Yoshiba M. Acute necrotizing esophagitis: role of nonsteroidal anti-inflammatory drugs. J Gastroenterol 2006; 41: 193-197.
  15. Liu YH, Lin YS, Chen HJ, Tu CY, Chen W. Klebsiella pneumoniae deep neck infection with acute necrotizing esophagitis. South Med J 2009; 102: 219.
  16. Mangan TF, Colley AT, Wytock DH. Antibiotic-associated acute necrotizing esophagitis. Gastroenterology 1990; 99: 900.
  17. Casarsa C, Mearelli F, Zanetti M, Biolo G. Black esophagus. Journal of Acute Medicine 2015; 5: 107-108.
  18. Gurvits GE, Robilotti JG. Isolated proximal black esophagus: etiology and the role of tissue biopsy. Gastrointest Endosc 2010; 71: 658.
  19. Raven RW, Dawson I. Malignant melanoma of the oesophagus. Br J Surg 1964; 51: 551- 555.
  20. Chang F, Deere H. Esophageal melanocytosis morphologic features and review of the literature. Arch Pathol Lab Med 2006; 130: 552-557.
  21. Kozlowski LM, Nigra TP. Esophageal acanthosis nigricans in association with adenocarcinoma from an unknown primary site. J Am Acad Dermatol 1992; 26: 348-351.