P2246 - Black Esophagus: A Compelling Case Report on Acute Esophageal Necrosis

Huzaif Taufiq, MD¹, Romy Chamoun, MD², Gracy Chamoun, BS³, Anastasia Shnitser, MD^2
1Jefferson Torresdale Hospital, Willow Grove, PA; ²Lehigh Valley Health Network, Allentown, PA; ³University of Balamand, Arlington, VA

Introduction: Acute esophageal necrosis (AEN), commonly referred to as “black esophagus”, is a rare clinical disorder that can affect the whole esophagus and abruptly terminates at the gastroesophageal junction. It is visualized during esophagogastroduodenoscopy (EGD) as a circumferential black coloration of the mucosa and is believed to arise from a combination of an ischemic insult along with disruption of mucosal barrier systems, and reflux of gastric secretions. AEN has a rapid progression with several complications such as stricture, perforation, mediastinitis, and death

Case Description/Methods: We present a 66-year-old male with a past medical history significant for type 2 diabetes, and hypertension who presented after falling off his bike. The patient was found to have an acute right femoral neck fracture and underwent right hip hemiarthroplasty. After the procedure, the patient reported dysphagia, attributing it to a sensation of food becoming lodged in his chest along with multiple episodes of emesis. The patient experienced similar symptoms of dysphagia the next morning, prompting consultation with the gastroenterology team. He did not report having any similar episodes in the past. The patient was kept NPO with IV hydration and esophagogastroduodenoscopy was scheduled. EGD results showed circumferential black discoloration of the distal esophagus with underlying friable hemorrhagic tissue and a sharp transition to normal appearing mucosa at the GE junction suggesting acute esophageal necrosis. The patient was treated with proton pump inhibitors along with sucralfate leading to symptomatic improvement over the next week. He remained hemodynamically stable and was discharged home a week later

Discussion: AEN is a life-threatening condition resulting in acute ischemia of the esophagus. There are no specific treatments for the black esophagus, with the mainstay of therapy consisting of treating the underlying cause and supportive care. The prognosis of AEN is poor, with a high mortality rate of approximately 32% associated with other critical conditions, however, the mortality rate specific to AEN is 6%. We hope that this case will raise awareness, early recognition, and timely institution of proper management, thereby increasing the chances of survival



Disclosures:


Huzaif Taufiq, MD¹, Romy Chamoun, MD², Gracy Chamoun, BS³, Anastasia Shnitser, MD². P2246 - Black Esophagus: A Compelling Case Report on Acute Esophageal Necrosis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.