Kim In Kyoung, Kim Joo Sung, Song In Sung
Departmemt of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2010 Nov;56(5):314-8. doi: 10.4166/kjg.2010.56.5.314.
Acute esophageal necrosis (AEN) is a very rare disorder typically presenting as a diffuse black esophageal mucosa on upper endoscopy. For this reason, AEN is often considered to be synonymous with 'black esophagus'. The pathogenesis of entity is still unknown. We report a case of AEN with duodenal ulcer causing partial gastric outlet obstruction. A 53-year-old man presented with hematemesis after repeated vomiting. The upper gastrointestinal endoscopy revealed circumferential black coloration on middle 315 to lower esophageal mucosa that stopped abruptly at the gastroesophageal junction. Pyloric ring deformity and active duodenal ulceration with extensive edema was observed. After conservative management with NPO and intravenous proton pump inhibitor, he showed clinical and endoscopic improvement. He resumed an oral diet on day 7 and was discharged. In our case the main pathogenesis of disease could be accounted for massive esophageal reflux due to transient gastric outlet obstruction by duodenal ulcer and following local ischemic injury.
急性食管坏死（AEN）是一种非常罕见的疾病，在内镜检查时通常表现为食管黏膜弥漫性变黑。因此，AEN常被认为是“黑色食管”的同义词。该疾病的发病机制尚不清楚。我们报告一例AEN合并十二指肠溃疡导致部分胃出口梗阻的病例。一名53岁男性在反复呕吐后出现呕血。上消化道内镜检查显示食管中下段黏膜呈环形黑色，在胃食管交界处突然停止。观察到幽门环畸形和活动性十二指肠溃疡伴广泛水肿。在禁食和静脉使用质子泵抑制剂进行保守治疗后，他的临床症状和内镜表现均有所改善。他在第7天恢复经口饮食并出院。在我们的病例中，疾病的主要发病机制可能是十二指肠溃疡导致短暂性胃出口梗阻，继而出现大量食管反流以及随后的局部缺血性损伤。
