Akhila Chilakala, MD, Sheyla Medina, MD, Brenton Davis, MD, Kunal Karia, MD, Jeffrey Fox, MD Kaiser Permanente, San Francisco, CA Introduction: Acute esophageal necrosis (AEN), or "black esophagus," is a rare, life-threatening condition often seen in critically ill patients with cardiovascular disease, hypotension, and/or multi-organ dysfunction. It presents as blackening of the esophageal mucosa, typically at the distal esophagus, and is associated with melena, hematemesis, and signs of hypoperfusion. With a 32% mortality rate, early diagnosis and supportive care (e.g., TPN, IV PPIs) are crucial.
Case Description/
Methods: Patient A: A 70-year-old male with severe comorbidities developed acute-on-chronic renal failure, respiratory failure, and AEN. Endoscopy revealed circumferential necrosis from mid to distal esophagus, likely due to ischemia and impaired mucosal repair. Despite supportive care, the patient died.
Patient B: An 84-year-old male developed AEN after coronary bypass surgery, presenting initially as melena. Endoscopy showed diffuse esophageal necrosis and duodenal ulcers. He required multiple endoscopies and embolizations for GI bleeding but healed after interventions and was eventually discharged.
Patient C: A 69-year-old female with acute pancreatitis and hypoxemic respiratory failure developed AEN due to esophageal hypoperfusion. Managed with PPIs and TPN, she showed mucosal healing and was able to be discharged. Discussion: This case series highlights the varied clinical presentations and outcomes of acute esophageal necrosis (AEN). While AEN typically shows a sharp transition between viable gastric mucosa and necrotic esophageal tissue, Patients B and C exhibited unusual findings, including rapid healing of esophagitis without persistent necrosis, suggesting the potential for quicker recovery with supportive care. Patient A, with severe comorbidities and systemic failure, experienced a fatal outcome due to multi-organ dysfunction and ischemia. In contrast, Patients B and C, despite severe presentations, recovered with appropriate interventions. This suggests that early diagnosis and management can improve outcomes, particularly in patients with fewer comorbidities.
Disclosures: Akhila Chilakala indicated no relevant financial relationships. Sheyla Medina indicated no relevant financial relationships. Brenton Davis indicated no relevant financial relationships. Kunal Karia indicated no relevant financial relationships. Jeffrey Fox indicated no relevant financial relationships.
Akhila Chilakala, MD, Sheyla Medina, MD, Brenton Davis, MD, Kunal Karia, MD, Jeffrey Fox, MD. P2858 - Acute Esophageal Necrosis in Critical Illness: Insights From a Case Series of Ischemia and Multi-Organ Dysfunction, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
