Idiopathic acute esophageal necrosis: not necessarily a terminal event

Abstract

Idiopathic acute esophageal necrosis (AEN) has been considered a rare event, usually having an ischemic origin. Primarily cases from autopsy studies have been reported. This report deals with 10 such cases which were diagnosed among some 80,000 esophago-gastroscopies performed during a 16-year period. Nine patients recovered and were discharged from the hospital. The esophageal lesions presented as a demarcated, black discoloration which usually evolved to a picture suggestive of unspecific esophagitis. Histology invariably revealed diffuse and conspicuous necrosis involving the mucosa, submucosa and, frequently, muscular layers. In 2 cases, esophageal stenosis developed and, in one case, a full-thickness necrosis made surgery with colon interposition mandatory. Hyperglycemia, hypoxia, carcinoma and ischemic phenomena were found as associated conditions. Gastroduodenal, acute ulcerative disease was present in four patients. From this experience, it is concluded that AEN is not necessarily a terminal phenomenon, notwithstanding that it is usually associated with pre-existent serious illness. Nevertheless, its etiology remains unknown.