P2251 - Black Esophagus: A Devastating Consequence - A Case Report and Comprehensive Literature Analysis

Nirav Agrawal, MD, MPH¹, Akshay Sharma, MD², Scarlet Louis-Jean, MD, MBA, MSAN³, Steven Fleisher, MD⁴, Sanmeet Singh, MD^3
1Luminis Health/ Anne Arundel Medical Center, Pasadena, MD; ²Annapolis, MD; ³Luminis Health, Annapolis, MD; ⁴Luminis Health Anne Arundel Medical Center, Annapolis, MD

Introduction: Acute esophageal necrosis, commonly known as "black esophagus," is a rare and potentially life-threatening condition characterized by circumferential black discoloration and necrosis of the esophageal mucosa. This report presents a case of black esophagus in a 79-year-old female with metastatic cancer and a review of the literature on this condition.

Case Description/Methods: A 79-year-old female with multiple comorbidities, including diabetes mellitus, hypertension, and hyperlipidemia, presented with upper gastrointestinal bleeding. Endoscopic evaluation revealed circumferential black discoloration of the esophagus, consistent with acute esophageal necrosis. The patient had advanced metastatic cancer with a poor prognosis and was managed with supportive care, including intravenous fluids, proton pump inhibitors, and sucralfate. Given her overall poor prognosis, no further interventions or follow-up endoscopy were pursued, and the patient was transitioned to hospice care.
A comprehensive review of the literature on black esophagus was conducted, including 68 cases from recent years. The mean age of patients was 60.37 years, with a male predominance (67%). Common presenting symptoms were hematemesis (55%), gastrointestinal symptoms (54%), and melena (19%). Significant comorbidities included diabetes mellitus (42%), alcohol use disorder (25%), and gastrointestinal conditions (25%). Malignancy was observed in 10% of cases. Age, low hemoglobin, and hypotension were identified as factors associated with increased mortality.



Discussion: Acute esophageal necrosis is a rare condition often associated with advanced age, comorbidities, and compromised vascular supply. Prompt diagnosis and management are crucial, with supportive care being the mainstay of treatment. In cases of advanced malignancy or poor prognosis, management may be tailored toward symptom control and palliation, considering the risks and benefits of invasive interventions.



Disclosures:


Nirav Agrawal, MD, MPH¹, Akshay Sharma, MD², Scarlet Louis-Jean, MD, MBA, MSAN³, Steven Fleisher, MD⁴, Sanmeet Singh, MD³. P2251 - Black Esophagus: A Devastating Consequence - A Case Report and Comprehensive Literature Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.