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Bloody esophagus

Adrian Săftoiu1, 2
1. Spitalul Universitar de Urgență Elias, UMF Carol Davila București, ROMÂNIA
2. Regina Maria - Ponderas Academic Hospital București, ROMÂNIA

History :

A 42-year-old patient, smoker and with a history of alcohol consumption, presented for an episode of upper gastrointestinal bleeding manifesting as hematemesis and melena.

Clinical & biological :

Chest pain, hematemesis and melena.

Imaging :

Upper GI endoscopy revealed a necrotic appearance of the esophagus, with confluent erosions and ulcerations (grade D esophagitis), with a granular mucosa with diffused bleeding during endoscopic maneuvers (Figure 1, 2 and 3, Video 1).

Diagnostic :

Acute necrotizing esophagitis.

Discussion :

Acute necrotizing esophagitis is a relatively rare cause of upper gastrointestinal bleeding with multifactorial etiopathogenesis (massive gastric reflux due to gastroparesis, viral infections, corrosive mucosal injury or caused by high-dose alcohol ingestion, diabetes, pulmonary diseases, chronic kidney disease or liver cirrhosis, etc.) which causes ischemic necrosis of the distal esophagus. More than 100 cases are described in the literature.
Treatment is generally conservative (supportive) and includes hydration therapy, proton pump inhibitors (PPIs) and sucralfate, antibiotics, etc. Surgery or endoscopic interventions are described in approximately 25% of patients who have complications (stenosis, fistulas, perforations). Mortality is about 30%.

Conclusion :

Acute necrotizing esophagitis is a rare entity with a variable clinical and endoscopic picture.

References :

1. Siddiqi A, Chaudhary FS, Naqvi HA, Saleh N, Farooqi R, Yousaf MN. Black esophagus: a syndrome of acute esophageal necrosis associated with active alcohol drinking. BMJ Open Gastroenterol 2020; 7(1): e000466.
2. Săftoiu A, Cazacu S, Kruse A, Georgescu C, Comănescu V, Ciurea T. Acute esophageal necrosis associated with alcoholic hepatitis: is it black or is it white? Endoscopy 2005; 37(3): 268-71.
3. Schizas D, Theochari NA, Mylonas KS, Kanavidis P, Spartalis E, Triantafyllou S, Economopoulos KP, Theodorou D, Liakakos T. Acute esophageal necrosis: A systematic review and pooled analysis. World J Gastrointest Surg 2020; 12(3): 104-115.
4. Shafa S, Sharma N, Keshishian J, Dellon ES. The Black Esophagus: A Rare But Deadly Disease. ACG Case Rep J 2016; 3(2): 88-91.

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