University of Puerto Rico School of Medicine Guaynabo, PR, United States
Felix Aponte Santos, MD1, Adelaida Ortiz Gomez, MD2, Artemio Santiago Molina, MD2, Adriana Suarez Cruz, MD2 1University of Puerto Rico School of Medicine, Guaynabo, Puerto Rico; 2University of Puerto Rico School of Medicine, San Juan, Puerto Rico
Introduction: Black esophagus, known as acute esophageal necrosis (AEN), is a rare life-threatening medical condition with an annual incidence of up to 0.28% . It is characterized by dark pigmented esophageal mucosa. AEN is multifactorial, and the exact etiology is unknown. The diagnosis can be made endoscopically, with the most common presenting symptom being upper GI bleed (UGIB) in 78-90% of cases [2,3]. We present a case of AEN with an atypical presentation that could help further characterize this disease.
Case Description/Methods: A 54 year old female with a history of metastatic pancreatic adenocarcinoma presents to the hospital due to non-bilious vomiting, difficulty swallowing, and upper abdominal discomfort. Abdomino-pelvic CT scan showed a pancreatic tail mass with findings suggestive of metastasis. One cycle of FOLFIRINOX chemotherapy regimen was given. Due to persistent PO intolerance, mechanical obstruction was suspected. Upper GI endoscopy revealed severe, diffuse, circumferential and continuous edema, ulcerations and black pigmentation from proximal esophagus up to GE junction where it abruptly stopped (Fig. 1). Her stomach and duodenum revealed normal mucosa. She was treated with IV fluids, PPI, IV antibiotics, bowel rest and TPN. Her symptoms rapidly deteriorated and 5 days later died.
Discussion: Most cases of AEN present in predominantly male, critically ill patients; and with multiple comorbidities . Signs of UGIB, commonly hematemesis or melena can be seen in roughly 90% of cases, yet this was not the presentation of our female patient . Moreover, there are few cases reported of AEN related to malignancy and the use of FOLFIRINOX . These potential associations should be considered in further studies to improve quality of life and outcomes in patients receiving this chemotherapeutic agent.
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Figure: Figure 1. Endoscopic images showing diffuse black esophagus
Disclosures: Felix Aponte Santos indicated no relevant financial relationships. Adelaida Ortiz Gomez indicated no relevant financial relationships. Artemio Santiago Molina indicated no relevant financial relationships. Adriana Suarez Cruz indicated no relevant financial relationships.
Felix Aponte Santos, MD1, Adelaida Ortiz Gomez, MD2, Artemio Santiago Molina, MD2, Adriana Suarez Cruz, MD2. P1016 - Deadly Abdominal Pain: A Curious Case of Black Esophagus, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.