Black esophagus induced by severe vomiting in a healthy young man

Abstract

Black esophagus is an uncommon entity that has been described only a few times previously. It is defined as a dark pigmentation of the esophagus associated with histologic mucosal necrosis. Most cases have no known etiology, although ischemia, nasogastric tube trauma, infection, gastric outlet obstruction, gastric volvulus, and hypersensitivity to antibiotics have all been suggested as possible causes. Herein we report the case of a young, healthy, athletic man who developed black esophagus due to severe vomiting after alcohol overindulgence and summarize the other published cases to date.

Black oesophagus: a rare disorder with potentially fatal outcome

“…alcohol abuse [16], malignancies [26], herpetic infection [7], poor nutritional status [4], immunocompromise [6] and ischemia due to cardiac pathology [13,15,25,27]. The latter five conditions can be excluded in our cases.…”

“…An erosive gastritis as additional bleeding source other than the necrosis of the oesophageal mucosa could be established by gross pathology and microscopical examination in two cases (cases 1 and 4). An association between black oesophagus and erosive gastritis has been observed endoscopically in some previously published cases, too [15,16,26]. However, we believe that the co-existence of both pathological conditions is most probably a coincidental, purely stress-related phenomenon rather than a specific pathological constellation.…”

“…It remains unclear which factors may induce or influence the development of necrosis of the entire oesophageal mucosa in such a homogenous pattern as observed here in one individual suffering from a particular debilitating condition but not in the other cases. In most clinical reports, the endoscopical finding of black oesophagus was completely reversible and oesophageal necrosis resolved completely with improvement of the associated disease and after supportive treatment including adequate caloric contribution, intravenous fluid administration and haemodynamic stabilisation thus reestablishing the conditions for a sufficient oesophageal blood supply [6,13,15,16,26,31]; oesophagectomy was required in only one case [12].…”

“…The latter five conditions can be excluded in our cases. However, none of the debilitating conditions previously described in association with black oesophagus or the pathogenetic mechanisms they may induce, can satisfactorily explain the pathological findings in all cases and, accordingly, the true aetiology and exact mechanisms accounting for the development of the disease remain as yet unknown [15,16,26,27]. It remains unclear which factors may induce or influence the development of necrosis of the entire oesophageal mucosa in such a homogenous pattern as observed here in one individual suffering from a particular debilitating condition but not in the other cases.…”

“…Most of these reports deal with the endoscopical appearance of the disease, focusing on its clinical picture and course. The knowledge of the histopathology of black oesophagus is based on a small number of microscopically examined biopsy specimens revealing mucosal necrosis and inflammation [11,15,16,26] but a detailed pathoanatomical description of the morphological correlates of this rare disorder is not available. To the best of our knowledge, only one study [14] has described the autopsy features of black oesophagus.…”