The Black Esophagus: A Rare But Deadly Disease

Shafa, Shervin; Sharma, Neil; Keshishian, Jonathan; Dellon, Evan S.

doi:10.14309/crj.2016.9

Cited by 35 publications

(39 citation statements)

References 9 publications

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“…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].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundAcute esophageal necrosis (AEN) is a rare clinical disorder. Esophageal stenosis or obstruction is one of severe complications, but there are a few reports about surgical treatments. In such a situation, it still remains controversial which to choose, esophagectomy or bypass operation.Case presentationA 61-year-old woman was admitted to the local hospital for septic shock with diabetic ketoacidosis due to necrotizing fasciitis of the right thigh. Three days later, she had hematemesis, and gastrointestinal endoscopy revealed black mucosal coloration throughout the entire esophagus. She was diagnosed as having AEN. Her general condition improved after intensive care, debridement, and treatment with antibiotics and a proton pump inhibitor; the esophageal mucosal color recovered. However, an esophageal stricture developed after 1 month, and the patient underwent gastrostomy to remove an esophageal obstruction after 3 months. She was referred to our hospital for surgical treatment 1 year and 4 months after the occurrence of AEN because of her strong desire for oral intake. Her medical condition was poor, and she could not walk due to generalized muscle weakness. After rehabilitation for 8 months, we performed an esophageal bypass using a gastric conduit via the percutaneous route rather than esophagectomy because of her multiple severe comorbidities including walking difficulty, chronic hepatitis C, cerebrovascular disease, and chronic renal failure. Minor leakage of the esophagogastrostomy occurred and was resolved with conservative treatment. The patient began oral intake on postoperative day 34 and was discharged on day 52.ConclusionEsophageal obstruction after AEN was successfully treated by esophageal bypass using a gastric conduit in a high-risk patient. Because the majority of patients with AEN have multiple severe comorbidities, assessing the medical condition of the patient adequately is important prior to choosing either an esophagectomy or bypass surgery.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…It is known that timely patient stabilization and fluid resuscitation play pivotal roles in properly managing these difficult patients [6]. Furthermore, as seen from other published cases on the topic, acid suppression with high dose intravenous proton pump inhibitors, nil-peros (NPO) restriction, and glycemic control should immediately be initiated [7]. However, with regard to adequate nutrition for patients, the management tends to be up to the discretion of the clinical provider.…”

Section: Discussionmentioning

confidence: 99%

Total Parenteral Nutrition Successfully Treating Black Esophagus Secondary to Hypovolemic Shock

Brar¹

2017

American Journal of Gastroenterology

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We present a patient who developed black esophagus secondary to hypovolemic shock and was placed on total parenteral nutrition for three weeks after hospital discharge. The area of interest is the multimodal approach used in treatment of this noncompliant patient. Even with a high mortality rate, this case illustrates a successful outcome of a patient who responded to appropriate immediate therapy resulting in complete resolution of the necrosis with no further development of complications.

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“…Case reports published in literature reviews were also included on the condition that patient history was sufficiently detailed. The endoscopy series initially included 88 publications, of which 26 publications on a total of 41 deceased patients were retained (Gurvits et al 2015;Ben Soussan et al 2002;Averbukh et al 2018;Barnes et al 2014;Day and Sayegh 2010;Del Hierro 2011;Essamri et al 2001;Grudell et al 2006;Julian Gomez et al 2008;Kalva et al 2016;Katsinelos et al 2004;Koop et al 2016;Lahbabi et al 2013;Maher and Nassar 2008;Odelowo et al 2002;Ramos et al 2008;Rodrigues et al 2016;Roman Fernandez et al 2014;Salem et al 2015;Shafa et al 2016;Shah et al 2017;Sharma et al 2016;Singh et al 2011;Wu and Wu 2014;Monteiro et al 2019;Khan et al 2019). The autopsy series initially comprised 13 publications, of which 11 publications on a total of 17 patients were retained in this review.…”

Section: Literature Review Methodsmentioning

confidence: 99%

Black esophagus as an autopsy discovery: a challenging interpretation

Kerschen

Schmit

Boosere

et al. 2020

Egypt J Forensic Sci

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Black esophagus is a rare medical condition, characterized by a circumferential blackish discoloration of the distal part of the esophageal mucosa, abruptly ending at the gastroesophageal junction. The etiology is multifactorial since patients suffer from multiple comorbidities. While the mortality rate specifically linked to black esophagus is only around 6%, the mortality rate linked to the underlying comorbidities amounts to 32%. A series of five cases is provided in which black esophagus was an unexpected discovery at autopsy. Black esophagus is generally considered being a challenge to the forensic pathologist. There are often no other major gross anomalies found at autopsy and information about the patient's medical history is not always available, which complicates a correct assessment. We present a review of the literature on black esophagus, limited to reports on deceased patients. The reviewed publications are divided into autopsy and endoscopy series to correctly compare the causes of death. The aim of this review is to identify a possible divergence in causes of death in autopsy and endoscopy series and additionally to analyze the causes of these differences to enable better assessment and interpretation of black esophagus at forensic autopsies. This paper emphasizes the importance of a minimal knowledge of the victim's comorbidities and medical record and the use of toxicology and postmortem biochemistry analysis as a valuable tool in investigating the cause of death in the setting of black esophagus.

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The Black Esophagus: A Rare But Deadly Disease

Cited by 35 publications

References 9 publications

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

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

Total Parenteral Nutrition Successfully Treating Black Esophagus Secondary to Hypovolemic Shock

Black esophagus as an autopsy discovery: a challenging interpretation

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