Bologna C*, Tremolaterra F, Madonna P and Rabitti PG
Internal Medicine Unit, Ospedale del Mare, Naples, Italy Gastroenterology and Digestive Endoscopy Unit, Ospedale del Mare, Naples, Italy Internal Medicine Unit, AORN A. Cardarelli, Naples, Italy
Posters & Accepted Abstracts: Health Sci J
Background: Black esophagus is a rare syndrome characterized by a circumferential black appearance of the esophageal mucosa that almost universally affects the distal esophagus and stops at the gastroesophageal junction. The etiology is unclear but in critically ill patients a combination of factors, such as ischemic mucosal insult, corrosive injury from reflux of the gastric contents, and possibly decreased function of the mucosal barrier and reparative mechanisms. Case History: We present a case of 89-year-old man who was hospitalized in a serious hypotensive state and frank signs of septic shock. After the urgent diagnostic work up the patient presented hematemesis and melena. At the subsequent upper endoscopy, the mucosal of the middle and distal esophagus appeared blackish as for necrotic phenomena. The patient started therapy with high dose of proton pump inhibitor (PPI) and no other bleeding events occurred. Discussion: The final diagnosis of the presented case is the acute esophageal necrosis (AEN) associated with gastrointestinal bleeding and septic shock. It must be recognized early and aggressively managed to improve clinical outcomes and thus to emphasize the importance of taking into account the AEN as one of the causes of upper gastrointestinal bleeding in the context of septic shock.
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