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- W2912557732 abstract "In the world of medicine, the word “necrosis” imbues a sense of urgency. From necrotizing fasciitis, to toxic epidermal necrolysis, to acute esophageal necrosis (AEN), the rapid autolysis of various tissues is an ominous sign. Mortality alone from AEN, also known as “ black esophagus”, is nearly 32%. Usually a result of ischemia, it is male predominant and risk factors include advanced age, diabetes, ICU stay and alcohol use. Diagnosis is usually made endoscopically. Here, we present a rare condition of AEN, diagnosed with esophagogastroduodenoscopy (EGD). A 57-year-old male with past medical history of type-2 diabetes, hypertension, cerebrovascular accident (CVA), non-obstructive coronary artery disease (CAD), presented with coffee ground emesis, and melena. His symptoms started with headache, nausea and coughing 3 days prior, for which he had been self-medicating with whiskey. Objectively: heart rate 112/min, blood pressure 81/49 mmHg. WBC 17,200/mm3, Hb 11.9 g/dl, platelets 170,000/mm3, Lactate 17.1 mmol/L, INR 1.2. He was fluid resuscitated, admitted to the ICU, started on proton pump inhibitor, octreotide drips, and infection prophylaxis with ceftriaxone in case this was a variceal bleed. Other differentials included peptic ulcer disease (PUD), Mallory-Weiss tear, vascular abnormalities, and tumor. Once stabilized, EGD showed a necrotizing esophagitis from the cricopharyngeal muscle to gastroesophageal junction (GEJ). Concerned for vascular ischemia, a CT-angiography was obtained which did not reveal vascular pathology though there was multivessel dense calcific coronary atherosclerosis. At first glance, this patient had the typical presentation of upper GI bleeding. However, the EGD diagnosed a rare condition of AEN. Interestingly, 90% of the time, AEN presents with melena or hematemesis. Endoscopically, the esophageal mucosa had a circumferential black color which terminated at the GEJ, indicating distal esophageal vascular compromise. The blood supply to the mid-esophagus arises from intercostal, bronchial and esophageal arteries. This creates a ‘watershed' region in the distal esophagus. Management consists of supportive care and treating the underlying causes. This cause of this patient's AEN consisted of all the usual suspects for ischemia. In patients such as this, while AEN might not be the first differential diagnosis for melena, index of suspicion should high and the supportive treatment is crucial.Figure: Acute Esophageal Necrosis #1.Figure: Acute Esophageal Necrosis #2.Figure: Acute Esophageal Necrosis #3" @default.
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- W2912557732 date "2017-10-01" @default.
- W2912557732 modified "2023-09-26" @default.
- W2912557732 title "All the Usual Suspects: A Case of Acute Necrotizing Esophagus" @default.
- W2912557732 doi "https://doi.org/10.14309/00000434-201710001-01746" @default.
- W2912557732 hasPublicationYear "2017" @default.
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