Septic shock-related acute esophageal necrosis and stenosis: three cases of acquired esophageal stenosis presenting a similar clinical course

Abstract

We present a case of acute esophageal necrosis (AEN) and two acquired esophageal stenosis cases which showed a similar clinical course after an episode of septic shock. Extensive stenosis of the distal esophagus developed in all cases, which were refractory to dilation therapy and required surgical intervention. The etiology of the latter two cases was deduced from the stenosis after septic shock-induced AEN. Since the diagnosis of AEN is based on its characteristic endoscopic findings which can only be confirmed at the onset of the disease, we therefore called these cases "septic shock-related esophageal stenosis" or abbreviated to "septic esophageal stenosis". Further study of similar cases is required for understanding the etiology and management of AEN and the relevant disorder which may cause esophageal stenosis.

Acute esophageal necrosis with esophagus perforation treated by thoracoscopic subtotal esophagectomy and reconstructive surgery on a secondary esophageal stricture: a case report

“…Esophageal stricture is a complication in the chronic phase of AEN. When reviewing literature, 20 of 164 patients progressed to esophageal stricture within 3 weeks to 2 months after the onset of AEN [8, 12–20]. The initial treatment in most AEN-induced stricture cases was endoscopic balloon dilation (EBD).…”

Successful bypass operation for esophageal obstruction after acute esophageal necrosis: a case report

“…A review of the literature found that 19 of 163 patients with AEN progressed to esophageal stricture 3 weeks to 2 months after the onset of AEN [3, 6–13]. Gurvits et al reported that coronary artery disease, recent surgery, and gastroduodenal pathology may be associated with esophageal stricture [1].…”

“…Gurvits et al reported that coronary artery disease, recent surgery, and gastroduodenal pathology may be associated with esophageal stricture [1]. Shichinohe et al [3] reported three cases of acquired esophageal stricture after AEN with septic shock and hypothesized that severe hypoperfusion of the middle to low esophagus due to septic shock may cause esophageal stricture after AEN. Our patient developed a state of severe septic shock and had both a hiatal hernia and duodenal ulcer at the time of the AEN diagnosis.…”

“…The majority of the 19 patients with esophageal stricture initially underwent EBD. However, five patients received surgical treatment for refractory esophageal stricture after repeated EBD, three patients underwent esophagectomy, and two patients had a bypass operation [3–5]. In most patients without surgical treatment, the follow-up duration was only a few months; therefore, more patients may have received surgical treatment.…”

“…Although esophageal stricture after AEN is often refractory to conservative therapy, there are a few reports of surgical intervention [3–5]. Herein, we report a rare case of successful esophageal bypass for esophageal obstruction after AEN.…”