P2300 - Acute Esophageal Necrosis: An Uncommon Culprit Behind Upper GI Bleeding

Jose W. Sotelo, MD¹, Akanksha Togra, MD¹, John Joyce, MD², Brian Lee, DO³, Pratyusha TIrumanisetty, MD^4
1Texas Tech University Health Sciences Center, El Paso, TX; ²SUNY Upstate Medical University, Syracuse, NY; ³Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, San Antonio, TX; ⁴Memorial Medical Center, El Paso, TX

Introduction: Acute esophageal necrosis (AEN), or "black esophagus," is a rare, serious condition marked by widespread necrosis of the esophageal mucosa. It often presents with upper gastrointestinal bleeding, sepsis, or signs of peripheral hypoperfusion, mainly affecting elderly patients with comorbidities like diabetes, cardiovascular disease, and chronic renal insufficiency. This report details the case of an 80-year-old female with poorly controlled diabetes who developed AEN during septic shock from emphysematous pyelonephritis.

Case Description/Methods: An 80-year-old female with poorly controlled diabetes presented to the Emergency Department in septic shock due to emphysematous pyelonephritis. Admitted to the ICU, she was treated with vasopressors and antibiotics. On the fourth day, she developed coffee-ground emesis and melena, with hemoglobin dropping from 12 g/dL to 7 g/dL. Despite this, she was hemodynamically stable and started on a proton pump inhibitor (PPI).

An esophagogastroduodenoscopy (EGD) showed diffuse esophageal necrosis sparing the gastroesophageal junction (Figure 1), with no active bleeding. A CT scan revealed esophageal wall thickening without perforation. The patient was kept NPO for 48 hours. Post-procedure, there was no further melena, and hemoglobin levels remained stable.

The patient tolerated a clear liquid diet, which was gradually advanced to regular consistency over two days. She was maintained on PPI twice daily for eight weeks, recovered well, and was discharged in stable condition.

Discussion: This case highlights the critical importance of early recognition and management of acute esophageal necrosis, particularly in patients with severe underlying conditions such as poorly controlled diabetes and sepsis. Despite the initial severe presentation and complications, including significant gastrointestinal bleeding, the patient responded well to conservative management with proton pump inhibitors, dietary modifications, and supportive care. Timely diagnosis via esophagogastroduodenoscopy and appropriate therapeutic interventions played crucial roles in her recovery.

This case underscores the necessity for vigilance in patients presenting with upper gastrointestinal symptoms in the setting of systemic illness, as prompt treatment can significantly improve outcomes in acute esophageal necrosis.



Disclosures:


Jose W. Sotelo, MD¹, Akanksha Togra, MD¹, John Joyce, MD², Brian Lee, DO³, Pratyusha TIrumanisetty, MD⁴. P2300 - Acute Esophageal Necrosis: An Uncommon Culprit Behind Upper GI Bleeding, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.