Acute esophageal necrosis: A rare case of upper gastrointestinal bleeding from diabetic ketoacidosis

Clin Pract. 2020 Jun 29;10(2):1254. doi: 10.4081/cp.2020.1254. eCollection 2020 May 19.

Abstract

Acute esophageal necrosis, also known as black esophagus or acute necrotizing esophagitis is a rare condition with roughly 154 cases reported in the literature. This condition is classically diagnosed on its endoscopic findings of a circumferentially black esophagus that abruptly ends at the gastroesophageal junction and transitions to normal gastric mucosa. When present, acute esophageal necrosis potentially signifies a poor prognosis with an overall mortality up to 36%. This case report describes a critically ill patient with multiple comorbidities that was found to have acute esophageal necrosis the entire length of the esophagus secondary to ischemia/hypoperfusion that was caused by diabetic ketoacidosis. The patient had a prolonged hospitalization but was ultimately discharged in stable condition. We also review the literature of this rare esophageal condition.

Keywords: Acute esophageal necrosis; acute necrotizing esophagitis; black esophagus; diabetic ketoacidosis; upper gastrointestinal bleed.