A dark and black esophagus

Submitted: 21 June 2024
Accepted: 3 July 2024
Published: 29 July 2024
Abstract Views: 268
PDF: 122
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Authors

A 70-year-old Italian man presented to our emergency department for dyspnea and confusion. He was affected by diabetes mellitus type 2, but he stopped his medication 10 days before. At admission, his vital signs were blood pressure of 60/50 mmHg, heart rate of 130 bpm, peripheral oxygen saturation of 94% in the Venturi Mask FiO2 40%, respiratory rate of 40/min, and body temperature of 36°C. Physical examination revealed hypoperfusion with a high Mottling Score and dark stools with a positive hydrogen peroxide reaction. He denied abdominal pain, nausea, and vomiting. Laboratory findings showed leucocytosis (White Blood Cells, WBC, 31,580/mm3; N 91.6%), Hemoglobin (Hb) 14.5 g/dL, Hematocrit Test (Hct) 49%, hyperglycaemia (>700 mg/L), and normal coagulation time. Arterial blood gas documented a metabolic acidosis with pH 6.95, Partial Pressure of Carbon Dioxide (pCO2) 27.5 mmHg, HCO3 7.1 mmol/L, lactate 8.14 mmol/L (normal value <2), and elevated anion gap metabolic. He was first treated with IV therapy as follows omeprazole 80 mg, tranexamic acid 1 g, Ringer acetate 1000 cc, sodium bicarbonate 8.4% 100 mL, and magnesium sulfate 2 g. Then, a continuous IV infusion of Ringer 150 mL/h and omeprazole 8 mg/h was started. An Esophagogastroduodenoscopy (EGD) was arranged and showed circumferential blackening of the distal half of the esophagus.

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Citations

Gurvits GE, Shapsis A, Lau N, et al. Acute esophageal necrosis: a rare syndrome. J Gastroenterol 2007;42:29-38. DOI: https://doi.org/10.1007/s00535-006-1974-z
Goldenberg SP, Wain SL, Marignani P. Acute necrotizing esophagitis. Gastroenterology 1990;98:493-6. DOI: https://doi.org/10.1016/0016-5085(90)90844-Q
Gurvits GE. Black esophagus: acute esophageal necrosis syndrome. World J Gastroenterol 2010;16:3219-25. DOI: https://doi.org/10.3748/wjg.v16.i26.3219
Akaishi R, Taniyama Y, Sakurai T, et al. Acute esophageal necrosis with esophagus perforation treated by thoracoscopic subtotal esophagectomy and reconstructive surgery on a secondary esophageal stricture: a case report. Surg Case Rep 2019;5:73. DOI: https://doi.org/10.1186/s40792-019-0636-3
Ziegler PE, Rosario Lora D, DeMeo M. An unusual case of black esophagus. ACG Case Rep J 2023;10:e01202. DOI: https://doi.org/10.14309/crj.0000000000001202
Averbukh LD, Mavilia MG, Gurvits GE. Acute Esophageal Necrosis: a case series. Cureus 2018;10:e2391. DOI: https://doi.org/10.7759/cureus.2391
Abdullah HM, Ullah W, Abdallah M, et al. Clinical presentations, management, and outcomes of acute esophageal necrosis: a systemic review. Expert Rev Gastroenterol Hepatol 2019;13:507-14. DOI: https://doi.org/10.1080/17474124.2019.1601555
Beg S, Rowlands D. Acute Oesophageal Necrosis: a case report and review of the literature. BJMP 2015;8:a829

How to Cite

Scarilli, F., & Tizzani, D. (2024). A dark and black esophagus. Emergency Care Journal, 20(3). https://doi.org/10.4081/ecj.2024.12738