Acute Esophageal Necrosis: A Rare Case of Upper Gastrointestinal Bleeding from Diabetic Ketoacidosis

Abstract

Acute esophageal necrosis, also known as black esophagus or acute necrotizing esophagitis is a rare condition with roughly 154 cases reported in the literature. This condition is classically diagnosed on its endoscopic findings of a circumferentially black esophagus that abruptly ends at the gastroesophageal junction and transitions to normal gastric mucosa. When present, acute esophageal necrosis potentially signifies a poor prognosis with an overall mortality up to 36%. This case report describes a critically ill patient with multiple comorbidities that was found to have acute esophageal necrosis the entire length of the esophagus secondary to ischemia/hypoperfusion that was caused by diabetic ketoacidosis. The patient had a prolonged hospitalization but was ultimately discharged in stable condition. We also review the literature of this rare esophageal condition.

"Black Esophagus" or Gurvits Syndrome: A Rare Cause of Upper Gastrointestinal Bleeding in Diabetic Ketoacidosis

“…Hyperglycemia in DKA leads to poor vascular flow and sustainable damage to the esophageal mucosal barrier [7,11]. Similarly, osmotic diuresis in DKA causes extreme volume depletion and hypoperfusion of the distal esophagus, resulting in ischemia and necrosis of the area [7,10,11]. Other associated comorbidities, end-stage renal disease in our case, can increase the risk and severity of AEN [2].…”

“…Black esophagus has been reported in a few cases in association with diabetic ketoacidosis (DKA) [3][4][5][6][7][8][9][10]. In particular, a literature review showed a strong association between DKA and AEN in acute gastrointestinal bleeding [10]. The exact mechanism is not fully understood but few have been suggested.…”

Black esophagus: A case of acute esophageal necrosis associated with diabetic ketoacidosis

“…The correlation between DKA and AEN has been described in the literature (14,(17)(18)(19)(20)(21)(22)(23). DKA has been reported to be one of the most common triggering events for AEN (3,4,9).…”

The Vital Role of Thanatochemistry in the Postmortem Diagnostic of Diabetic Ketoacidosis—Case Report

“…Wischnewsky gastric lesions and acute esophageal necrosis were also not identified in our case. The presence of hemorrhage in the gastric lumen is at least interesting, and we have the courage to say that if death would have occurred later, there would have been the possibility for the Wischnewsky spots to appear or even for acute esophageal necrosis to develop [12,13]. Many autopsies performed on DKA cases that have been reported in the literature speak about the absence of characteristic macro and microscopic changes [6,36].…”

“…There are authors who consider Armanni-Ebstein kidney injuries as pathognomonic for DKA [9,10]. Recent studies correlate Wischnewsky gastric lesions and acute esophageal necrosis with death caused by DKA [11][12][13].…”