Shah Aun R, Landsman Marc, Waghray Nisheet
Internal Medicine, Case Western Reserve University School of Medicine / Metrohealth Medical Center, Cleveland, USA.
Gastroenterology & Hepatology, Case Western Reserve University School of Medicine / Metrohealth Medical Center, Cleveland, USA.
Cureus. 2019 May 27;11(5):e4761. doi: 10.7759/cureus.4761.
Acute esophageal necrosis (AEN) is a rare life-threatening illness that is being increasingly recognized in the past two decades. It usually develops in the setting of severe systemic illness due to a combination of tissue hypoperfusion, impaired mucosal defenses and gastric reflux. The most common presentation is with upper gastrointestinal bleeding complicating diabetic ketoacidosis, sepsis, pancreatitis, trauma, shock, renal failure, alcohol poisoning or other states of hemodynamic compromise. The classic finding on endoscopy is of necrosis of the distal esophagus with a sharp transition to normal gastric mucosa at the gastroesophageal junction. Management is aimed at treating the underlying insult and providing supportive care. We report a case of "black esophagus" complicating an episode of diabetic ketoacidosis in a 34-year-old male. The patient was treated with broad-spectrum antibiotics, antifungals and a high-dose proton pump inhibitor in addition to the treatment of ketoacidosis. No serious acute or long-term complication was identified and follow-up endoscopy showed resolution of necrosis.
急性食管坏死（AEN）是一种罕见的危及生命的疾病，在过去二十年中越来越受到关注。它通常在严重的全身性疾病背景下发生，是组织灌注不足、黏膜防御功能受损和胃反流共同作用的结果。最常见的表现是上消化道出血，并发于糖尿病酮症酸中毒、败血症、胰腺炎、创伤、休克、肾衰竭、酒精中毒或其他血流动力学不稳定状态。内镜检查的典型发现是食管远端坏死，在胃食管交界处与正常胃黏膜有明显分界。治疗旨在处理潜在病因并提供支持性护理。我们报告一例34岁男性糖尿病酮症酸中毒发作并发“黑色食管”的病例。除了治疗酮症酸中毒外，患者还接受了广谱抗生素、抗真菌药物和高剂量质子泵抑制剂治疗。未发现严重的急性或长期并发症，随访内镜检查显示坏死已消退。
