Black Esophagus in the Setting of Diabetic Ketoacidosis: A Rare Finding from Our Institution

Ghoneim, Sara; Shah, Aun R.; Dalal, Shaman; Landsman, Marc; Kyprianou, Annette

doi:10.1159/000504434

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…The disease has an incidence of 0.01% to 0.2%, more common in men, in the sixth decade of life. 3 -5 In our patient, the cause of AEN is thought to be secondary to alcohol intoxication, large IVC thrombus, and gastric acid reflux. Multiple theories are proposed to explain the pathogenesis of black esophagus, including ischemia, infections, hypothermia, gastric outlet obstruction, medications (in particular antipsychotic medications), hypercoagulable state, diabetic ketoacidosis, hypoproteinemia, cirrhosis, malignancy, and caustic injury.…”

Section: Discussionmentioning

confidence: 74%

Endoscopic Treatment of Black Esophagus With Fully Covered Metallic Stent

Bayati

Badhiwala

Obaidi

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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Acute esophageal necrosis (AEN) is a condition characterized by black appearance and inflammation of the esophagus. Our patient developed AEN presenting in the setting of alcohol intoxication and extensive inferior vena cava thrombosis. Esophagogastroduodenoscopy showed blood and black discoloration of the middle and lower esophagus with oozing. To control bleeding, a self-expandable fully covered metallic esophageal stent was placed. Multiple studies and reviews agree that the initial management for AEN is supportive care, resuscitation, and proton pump inhibitors to protect the esophageal mucosa from injury from acid reflux. Our case highlights the benefits of esophageal stent placement to manage AEN with active bleeding.

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Section: Discussionmentioning

confidence: 74%

Endoscopic Treatment of Black Esophagus With Fully Covered Metallic Stent

Bayati

Badhiwala

Obaidi

et al. 2022

Journal of Investigative Medicine High Impact Case Reports

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“…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).…”

Section: Discussionmentioning

confidence: 92%

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

Kitawaki¹,

Nishida²,

Sakai³

et al. 2021

Preprint

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“…DKA is known to be one of the most common etiologies of AEN. 5 The associated chronic atherosclerotic changes that can result in diminished baseline perfusion and the acute hypoperfusion related to the low-flow state in the setting of osmotic diuresis are thought to be factors that predispose diabetic patients to AEN. 3 Due to its relatively limited blood supply, the distal esophagus is preferentially affected, while findings of panesophageal involvement is less common.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient developed AEN likely due to profound hemodynamic compromise in the setting of hypovolemic shock due to DKA. DKA is known to be one of the most common etiologies of AEN 5 . The associated chronic atherosclerotic changes that can result in diminished baseline perfusion and the acute hypoperfusion related to the low‐flow state in the setting of osmotic diuresis are thought to be factors that predispose diabetic patients to AEN 3 .…”

Section: Discussionmentioning

confidence: 99%

Acute esophageal necrosis complicated by refractory stricture formation

Sandhu

Wang²,

Prajapati

2021

JGH Open

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Acute esophageal necrosis (AEN) is a rare presentation of severe esophageal injury. The optimal long‐term management of complications related to AEN, particularly stricture formation, are not well defined. We report a case of AEN in a patient who presented with diabetic ketoacidosis (DKA) and had dysphagia due to refractory stricture formation after mucosal healing occurred. A 62‐year‐old male with diabetes mellitus presented with altered mental status. He was admitted for hypovolemic shock secondary to DKA and treated with vasopressors, fluid resuscitation, and insulin. After resolution of DKA, he reported persistent dysphagia. Upper endoscopy showed circumferential black mucosal discoloration throughout the entire esophagus that spared the gastroesophageal junction. He was diagnosed with AEN and was continued on a proton pump inhibitor and sucralfate with improvement in symptoms. Repeat endoscopy 4 weeks later showed a 10‐cm benign‐appearing stricture in the mid esophagus. He underwent dilation with temporary symptomatic relief; however, recurrence in symptoms has thus far necessitated a total of 10 repeat upper endoscopies, including repeat dilations along with local steroid injection therapy. AEN is a rare presentation of severe esophageal injury and is typically associated with severe hemodynamic compromise. Although most cases resolve with supportive care and mucosal healing, there is little information regarding prognosis and optimal management of complications, such as refractory esophageal strictures. We describe a case of AEN complicated by refractory symptomatic esophageal stricture despite several dilations and intralesional steroid injections and discuss our approach to treatment.

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Black Esophagus in the Setting of Diabetic Ketoacidosis: A Rare Finding from Our Institution

Cited by 7 publications

References 15 publications

Endoscopic Treatment of Black Esophagus With Fully Covered Metallic Stent

Endoscopic Treatment of Black Esophagus With Fully Covered Metallic Stent

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

Acute esophageal necrosis complicated by refractory stricture formation

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