ACUTE ESOPHAGEAL NECROSIS IN A 48-YEAR-OLD FEMALE PATIENT: CASE REPORT

Abstract

DOI: https://doi.org/10.46296/gt.v8i16.0301

Abstract

Introduction: Acute esophageal necrosis (AEN), also known as “black esophagus,” is a rare condition characterized endoscopically by the presence of diffusely blackened esophageal mucosa, with predominant involvement of the distal third and abrupt transition to healthy mucosa at the gastroesophageal junction. It is associated with hemodynamic instability, severe comorbidities, and high overall mortality, although a significant proportion of deaths are related to the underlying disease rather than the esophageal injury itself. Objective: To describe the case of a 48-year-old female patient with acute esophageal necrosis diagnosed by upper digestive endoscopy, highlight the clinical and endoscopic features, and briefly review the pathophysiological, diagnostic, and therapeutic aspects in light of the current literature. Case presentation: A 48-year-old female patient with a history of poorly controlled type 2 diabetes mellitus, hypertension, and grade I obesity presented with hematemesis, melena, and sudden-onset epigastric pain in the context of infectious gastroenteritis with severe dehydration and hypotension. On admission, she presented with moderate anemia, metabolic acidosis, and mild elevation of creatinine. Upper gastrointestinal endoscopy revealed black, friable esophageal mucosa with circumferential involvement from the middle third to the distal third, with an abrupt transition at the gastroesophageal junction and no significant gastric lesions. Conservative management was established with aggressive hemodynamic resuscitation, suspension of oral intake, high-dose intravenous proton pump inhibitors, and nutritional support. The outcome was favorable, with no perforation or mediastinitis, and endoscopic follow-up at four weeks showed almost complete re-epithelialization with mild scarring. Conclusions: Acute esophageal necrosis is a rare cause of upper gastrointestinal bleeding, but with high mortality associated with comorbidities. Early recognition in patients with risk factors and hemodynamic compromise, timely upper gastrointestinal endoscopy, and early initiation of intensive support measures are essential to improve prognosis. This case illustrates an uncommon presentation due to the patient's age and sex and reinforces the need to maintain a high index of clinical suspicion.

Keywords: acute esophageal necrosis; black esophagus; upper gastrointestinal bleeding; esophageal ischemia; case report.