Acute Esophageal Necrosis (Black Esophagus) in the Setting of Cardiac Arrhythmia: A Case Report.

Acute esophageal necrosis is a rare (0.01%) and life-threatening condition (5% specific-mortality) involving blackening of the esophagus mucosa resulting from a combination of ischemic damage and gastric acid reflux, although the exact pathophysiology is still unclear. A 70-year-old female patient was admitted to the intensive care unit following two episodes of hematemesis. Her medical history included diabetes mellitus and ischemic heart disease. At admission an inaugural complete atrial fibrillation was discovered on electrocardiogram. Biological and bacteriological tests revealed urinary tract infection. An esophageo-gastro-duodenoscopy showed typical blackening of the lower third of the esophagus. Treatment consisted of intravenous fluids, high-dose proton pump inhibitors, nothing through the mouth status and intravenous antibiotic therapy. Repeat esophageo-gastro-duodenoscopy showed significant improvement. However, her condition deteriorated as she succumbed to septic shock. Our patient presented with negative prognostic factors like advanced age, diabetes mellitus, ischemic heart disease and inaugural arrhythmia that may have contributed to the development of acute esophageal necrosis.