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Case Reports
. 2021 Jul 5;15(2):594-597.
doi: 10.1159/000517235. eCollection 2021 May-Aug.

Acute Esophageal Necrosis Secondary to a Paraesophageal Hernia

Chris J Li  1 , Benjamin B Claxton  1 , Peter Block  1 , Sean Reilly  1 , Scott Manski  2 , Cuckoo Choudhary  2
Affiliations
Case Reports

Acute Esophageal Necrosis Secondary to a Paraesophageal Hernia

Chris J Li et al. Case Rep Gastroenterol. .

Abstract

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.

Keywords: Acute esophageal necrosis; Black esophagus; Hematemesis; Paraesophageal hernia.

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Conflict of interest statement

All authors have no declared or potential conflicts of interests that may compromise the design and conduct of the study, collection, analysis and interpretation of the data, and the preparation, review, or approval of the manuscript. Cuckoo Choudhary has had full access to all the data in the study and takes responsibility for the integrity of the data.

Figures

Fig. 1
Fig. 1
a, c Endoscopic findings from admission, demonstrating acute, circumferential necrosis of the esophagus extending to the esophagogastric junction. b, Endoscopic findings about 30 days after admission, revealing mucosal healing. d, A retroflexed endoscopic view in the stomach showing the paraesophageal hernia.
See this image and copyright information in PMC

References

    1. Geller A, Aguilar H, Burgart L, Gostout CJ. The black esophagus. Am J Gastroenterol. 1995;90((12)):2210–2. - PubMed
    1. Gurvits GE, Shapsis A, Lau N, Gualtieri N, Robilotti JG. Acute esophageal necrosis: a rare syndrome. J Gastroenterol. 2007;42((1)):29–38. - PubMed
    1. Jacobsen NO, Christiansen J, Kruse A. Incidence of oesophageal necrosis in an autopsy material. APMIS. 2003;111((5)):591–4. - PubMed
    1. Gurvits GE. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol. 2010;16((26)):3219–25. - PMC - PubMed
    1. Nunes G, Patita M, Fernandes V, Fonseca J. Paraesophageal hernia and gastric volvulus: an uncommon etiology of vomiting and upper gastrointestinal bleeding. Rev Esp Enferm Dig. 2017;109((4)):294–5. - PubMed

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