Balducci Daniele, Quatraccioni Claudia, Daretti Luigi Maria, Montori Michele, Bendia Emanuele, Maroni Luca, Benedetti Antonio
Clinic of Gastroenterology, Hepatology, and Emergency Digestive Endoscopy, Università Politecnica delle Marche, 60126 Ancona, Italy.
SOD Malattie Apparato Digerente, Endoscopia Digestiva, Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti, 60126 Ancona, Italy.
Reports (MDPI). 2023 Aug 7;6(3):37. doi: 10.3390/reports6030037.
Black esophagus or acute esophageal necrosis is characterized by circumferential black discoloration of the distal esophageal mucosa. It is a rare condition with a multifactorial pathogenesis, and its most common clinical presentation is acute upper gastrointestinal bleeding. It usually affects elderly patients with multiple comorbidities and is associated with a high mortality rate. This is a case report of a 90-year-old man with multiple comorbidities, including diabetes mellitus, atrial fibrillation with complete atrioventricular block, and a history of ischemic stroke, who presented to the emergency department for a syncopal episode followed by coffee ground emesis. Thoraco-abdominal computer tomography showed thickening of the distal esophagus and ruled out major complications such as perforation. The following esophagogastroduodenoscopy showed black circumferential necrosis of the mid and distal esophagus. Multiple irregular ulcers with black necrotic areas were also present in the bulb and second duodenal portion. During the hospitalization, the patient was treated with PPI, NPO nutrition, and broad-spectrum antibiotics with benefits. Two months later, the patient returned to the emergency department due to a new episode of hematemesis with endoscopic evidence of esophageal stricture without necrosis and recurrence of duodenal ulcers. After a few days, the patient died due to worsening of the underlying comorbidities. A black esophagus is associated with duodenal ulcers, which may recur and are possibly due to a common ischemic origin. In this case report, we explore the potential link between black esophagus and duodenal ulcers, discussing the underlying mechanisms and relevant literature supporting this association.
黑色食管或急性食管坏死的特征是食管远端黏膜出现环形黑色变色。它是一种罕见疾病，发病机制多因素，最常见的临床表现是急性上消化道出血。它通常影响患有多种合并症的老年患者，且死亡率高。本文报告一例90岁男性患者，患有多种合并症，包括糖尿病、伴有完全性房室传导阻滞的心房颤动以及缺血性中风病史，因晕厥发作后出现咖啡渣样呕吐物而就诊于急诊科。胸腹部计算机断层扫描显示食管远端增厚，排除了穿孔等主要并发症。随后的食管胃十二指肠镜检查显示食管中下段环形黑色坏死。十二指肠球部和第二部也存在多个伴有黑色坏死区域的不规则溃疡。住院期间，患者接受质子泵抑制剂、禁食营养支持及广谱抗生素治疗，病情好转。两个月后，患者因再次出现呕血返回急诊科，内镜检查显示食管狭窄但无坏死，十二指肠溃疡复发。几天后，患者因基础合并症恶化死亡。黑色食管与十二指肠溃疡相关，十二指肠溃疡可能复发，可能源于共同的缺血性病因。在本病例报告中，我们探讨了黑色食管与十二指肠溃疡之间的潜在联系，讨论了潜在机制及支持这种关联的相关文献。
