Acute esophageal necrosis and low-flow state

Abstract

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.

Figure 1)

Normal stomach mucosa stained with blood (upper left) and distal esophagus with active bleeding (upper right). Black esophagus revealed after irrigation and active bleeding sites identified (lower left), and transitional zone intact (lower right)

Figure 2)

Gastroesophageal junction (upper left and right), transitional zone (lower left) and middle one-third of the esophagus (lower right)