Eric A. Wien
University of Hawaii School of Medicine
Acute esophageal necrosis (AEN) is a rare but important cause of hematemesis, melena, dysphagia, and chest pain typically seen in patients with vascular disease in which esophageal necrosis circumferentially embodies the esophagus with GEJ (gastroesophageal junction) sparing. We present the case of chest pain and hematemesis secondary to AEN.
A 70-year-old male with ESRD, DM, prior CVA on Eliquis, with altered mental status, hypotension, neck, back, and chest pain. In the ED, he was hypotensive 67/51mmHg, and had coffee ground emesis. Hemoglobin decreased from 9.9 to 7.1g/dL requiring blood transfusions, PPI drip, and ICU admission. Upper endoscopy demonstrated diffuse, severe mucosal necrosis with black necrotic tissue in the middle and lower thirds of the esophagus (Figure 1, 2), but with normal tissue and sparing of the GEJ (Figure 3). A percutaneous gastrojejunostomy tube was placed. The patient had clinical improvement, but expired after a prolonged hospital course.