Resident Physician Parkview Medical Center Pueblo, CO
Benjamin Pottebaum, DO, Jimmy Giang, DO, Chris Calcagno, DO; Parkview Medical Center, Pueblo, CO
Introduction: Acute esophageal necrosis (AEN) is a rare syndrome characterized as diffuse, circumferentially black appearing esophagus on endoscopy. It is typically associated with the distal esophagus. Presentation is usually associated with upper GIB. The exact pathophysiology is not fully understood but believed to be due to a combination of ischemia, mucosal breakdown, and backflow injury from gastric contents. Previous literature reviews show that there have been roughly 88 cases over a 40 year period. Most cases affect men in their sixth-to-seventh decade of life. Additionally, the mortality rate, in combination with other comorbidities, has been shown to approach 32%. We report a case of AEN in a young male in the setting of DKA and superior mesenteric artery syndrome.
Methods: A 23 year-old male with a past medical history of IDDM presented with sudden onset abdominal pain and coffee-ground emesis with a reported 30-40 pounds of unintentional weight loss in the last month. A NG tube was placed on admission with removal of 3 liters of coffee-ground output. CT of the abdomen and pelvis showed a distended and fluid-filled stomach with fluid seen within the first duodenal portion. Because of the fluid within the first duodenal portion, superior mesenteric artery syndrome was considered. Admission Hgb was 15.3 and within 24 hours, dropped to 10.6. Patient was noted to be in atrial fibrillation with a rapid ventricular rate (new diagnosis) and admitted to the ICU. EGD revealed a diffusely erythematous, black, necrotic appearance to the esophagus, ulcerations within the gastric antrum, duodenal bulb, and first portion of the duodenum. Extraluminal narrowing of the second portion of the duodenum was observed without obstruction. A CTA of the abdomen and pelvis was performed to further clarify the extraluminal narrowing. Results showed a decreased aortomesenteric angle and decreased aortomesenteric distance. The patient was continued on high-dose PPI therapy and on clinic follow-up, had resolution of his symptoms. Repeat endoscopy is scheduled in the near future. Discussion: AEN is a rare syndrome seen on endoscopic evaluation. Although the specific etiology of this patient’s AEN is unclear, our case is unique in that he is young but had multiple potential causes of AEN. Because of the rarity of an AEN diagnosis and little literature available, it is important to be cognisant of acute esophageal necrosis given the high mortality rate in conjunction with other comorbidities.
Lower third and middle of the esophagus
Middle third of the esophagus to the upper third of the esophagus
GE junction as well as stomach fundus
Disclosures: Benjamin Pottebaum indicated no relevant financial relationships. Jimmy Giang indicated no relevant financial relationships. Chris Calcagno indicated no relevant financial relationships.