Shah Amish, Thoguluva Chandreskar Viveksandeep, Doobay Ravi, Kahlon Arundeep, Amzuta Ioana
Internal Medicine Department, State University of New York Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA.
Gastroenterology Department, State University of New York Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA.
Case Rep Gastrointest Med. 2017;2017:5092906. doi: 10.1155/2017/5092906. Epub 2017 Jun 19.
We present a patient who presented to the ICU after successful resuscitation from cardiac arrest who was subsequently diagnosed with AEN.
A 66-year-old female presented after cardiac arrest in which return of spontaneous circulation was achieved within 7 minutes after the initiation of CPR. She was intubated on the scene and found to have coffee ground emesis in her bathroom when found unresponsive. Due to the hemodynamically significant GI bleed, patient was started on IV proton pump inhibitor, octreotide, and levophed. Subsequent endoscopy showed diffuse severe mucosal changes characterized by blackness, erythema, friability, granularity, inflammation, and decreased vascular pattern in the middle third of the esophagus and in the lower third of the esophagus.
AEN is a rare syndrome with a prevalence ranging from 0.001 to 0.2% of EGD. This patient is especially rare as this patient was female and had AEN in the middle esophagus along with lower esophagus. The pathophysiology in this patient is hypothesized that she had cardiac arrest secondary to acute upper GI hemorrhage. Subsequent low-flow state (cardiac arrest) in addition to being in the setting of severe alcohol abuse led to esophageal necrosis.
我们报告一名患者，该患者在心脏骤停成功复苏后被送入重症监护病房（ICU），随后被诊断为急性食管坏死（AEN）。
一名66岁女性在心脏骤停后就诊，心肺复苏（CPR）开始后7分钟内实现了自主循环恢复。她在现场接受了气管插管，被发现无反应时在浴室中有咖啡渣样呕吐物。由于存在血流动力学上显著的胃肠道出血，患者开始静脉使用质子泵抑制剂、奥曲肽和去甲肾上腺素。随后的内镜检查显示，食管中三分之一和下三分之一出现弥漫性严重黏膜改变，特征为发黑、红斑、易碎、颗粒状、炎症以及血管纹理减少。
急性食管坏死是一种罕见综合征，在食管胃镜检查（EGD）中的患病率为0.001%至0.2%。该患者尤为罕见，因为她是女性，且食管中三分之一和下三分之一均出现急性食管坏死。推测该患者的病理生理过程为，她因急性上消化道出血继发心脏骤停。随后的低血流状态（心脏骤停），加之处于严重酒精滥用的背景下，导致了食管坏死。
