Loghmari Mohamed Hichem, Ben Mansour Wafa, Guediche Arwa, Bouhlel Wided, Gahbiche Mourad, Safer Leila
Tunis Med. 2018 Feb;96(2):142-147.
Acute esophageal necrosis, also known as black esophagus, is a rare digestive complication, frequently manifested by an upper gastrointestinal hemorrhage and occurs in patients with comorbidities.
To report the case of a patient with a black esophagus revealed by an upper gastrointestinal hemorrhage.
A 72-year-old patient with a history of diabetes mellitus, hypertension and ischemic heart disease was hospitalized in surgical intensive care unit for hemorrhagic shock induced by cholecystectomy. On the 7th postoperative day, the patient developed acute hematemesis. Gastroscopy showed circumferential necrosis, localized in the middle and lower third of the esophagus and stopped abruptly at the gastroesophageal junction. Gastric mucosa was strictly normal. The bulb and the first part of duodenum showed multiple superficial ulcers without signs of recent hemorrhage. The patient was placed on absolute diet and total parenteral nutrition associated with high-dose intravenous proton pump inhibitor. Second-look gastroscopy, performed six days later, showed a significant improvement in esophageal lesions. The evolution was marked by the occurrence of pneumonia complicated by septic shock which caused patient's death.
Black esophagus is a rare pathology of multifactorial etiology. Treatment is based on proton pump inhibitors in combination with resuscitation measures to control comorbidities. Mortality remains high due to the seriousness of comorbid disease states often associated with this condition.
急性食管坏死，又称黑色食管，是一种罕见的消化系统并发症，常以上消化道出血为表现，多见于合并其他疾病的患者。
报告一例因上消化道出血发现黑色食管的患者病例。
一名72岁患者，有糖尿病、高血压和缺血性心脏病史，因胆囊切除术后出血性休克入住外科重症监护病房。术后第7天，患者出现急性呕血。胃镜检查显示食管中下段呈环形坏死，在胃食管交界处突然停止。胃黏膜完全正常。十二指肠球部和第一部有多个浅表溃疡，无近期出血迹象。患者接受绝对禁食，并给予全胃肠外营养，同时静脉注射大剂量质子泵抑制剂。6天后进行的再次胃镜检查显示食管病变有明显改善。病情发展过程中出现肺炎并并发感染性休克，导致患者死亡。
黑色食管是一种病因多因素的罕见病症。治疗以质子泵抑制剂联合复苏措施控制合并症为主。由于常与此病症相关的合并症病情严重，死亡率仍然很高。
