A Case of Acute Esophageal Necrosis with Gastric Outlet Obstruction

In Kyoung Kim; Joo Sung Kim; In Sung Song

doi:10.4166/kjg.2010.56.5.314

Journal List > Korean J Gastroenterol > v.56(5) > 1006736

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Kim, Kim, and Song: A Case of Acute Esophageal Necrosis with Gastric Outlet Obstruction

Original Article

Korean J Gastroenterol 2010;56(5):314-318.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.5.314

A Case of Acute Esophageal Necrosis with Gastric Outlet Obstruction

In Kyoung Kim, M.D., Joo Sung Kim, M.D., In Sung Song, M.D.

Departmemt of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Correspondence to: In Kyoung Kim, M.D. Liver Research Institute, Seoul National University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea Tel: +82-2-2072-4012, Fax: +82-2-766-3276 E-mail: ikkim1003@hanmail.net

Received 30 March 2010 Accepted 25 May 2010

Abstract

Acute esophageal necrosis (AEN) is a very rare disorder typically presenting as a diffuse black esophageal mucosa on upper endoscopy. For this reason, AEN is often considered to be synonymous with ‘black esophagus’. The pathogenesis of entity is still unknown. We report a case of AEN with duodenal ulcer causing partial gastric outlet obstruction. A 53-year-old man presented with hematemesis after repeated vomiting. The upper gastrointestinal endoscopy revealed circumferential black coloration on middle 315 to lower esophageal mucosa that stopped abruptly at the gastroesophageal junction. Pyloric ring deformity and active duodenal ulceration with extensive edema was observed. After conservative management with NPO and intravenous proton pump inhibitor, he showed clinical and endoscopic improvement. He resumed an oral diet on day 7 and was discharged. In our case the main pathogenesis of disease could be accounted for massive esophageal reflux due to transient gastric outlet obstruction by duodenal ulcer and following local ischemic injury.

Keywords: Acute esophageal necrosis, Black esophagus, Duodenal ulcer, Gastric outlet obstruction

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Fig. 1.

Endoscopic images of case. Black colored esophageal mucosa was noted through middle to lower esophagus (A) that ended sharply at gastroesophageal junction. (B) Extensive ulceration and edematous mucosa was also noted.

Fig. 2.

CT image of case. Deep ulceration at pylorus and duodenal bulb area caused the deformity and stricture of gastric outlet.

Fig. 3.

Follow up endoscopic image. Shallow ulceration with whitish exudates substituted previous black pigmented esophageal mucosa. 6 days after the restriction of oral feeding and intravenous administration of proton pump inhibitor.

Fig. 4.

Microscopic findings of esophageal mucosa. Biopsy which was performed at follow up endoscopy showed inflammatory exudates and inflammatory granulation tissue including apoptotic cells and regenerating cells (H&E stain, ×400).

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