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• W2977774883 abstract "Acute esophageal necrosis (AEN, also commonly known as “black esophagus”) is a rarely described cause of upper gastrointestinal (GI) bleed, with an incidence of less than 0.01% in hospitalized patients. Here we present a case of a 72-year-old female who developed AEN after initiation of hemodialysis for acute on chronic renal failure. A 72-year-old female with a history of rheumatoid arthritis and chronic renal disease was admitted to our hospital for viral pneumonia. Her course was complicated by worsening renal function, requiring initiation of hemodialysis. She experienced two episodes of loss of consciousness during her first dialysis treatment, likely due to hypoperfusion. The following day, the patient developed multiple episodes of small-volume hematemesis and melena, with an acute drop in hemoglobin from 9 mg/dL to 5 mg/dL. Upper endoscopy revealed a black circumferential area of necrosis of the proximal esophagus. The patient received supportive treatment with nasogastric tube, proton-pump inhibitor therapy and oral intake rest. Follow-up endoscopy one week later showed complete resolution of her esophageal injury. The patient resumed oral intake without difficulty, and was discharged to rehab three weeks after admission. AEN is characterized by a circumferential, dark pigmented, black appearance of the esophagus with friable mucosa seen on upper endoscopy. AEN usually affects the distal 2/3 of the esophagus with sharp demarcation at the gastroesophageal junction, although it can affect the proximal esophagus as seen in this case. On pathologic examination of the tissue, mucosal and submucosal necrosis with heavy leukocyte infiltration is seen. Various mechanisms have been hypothesized for development of AEN, including ischemia/hypoperfusion, impaired mucosal barriers, chemical injury, infection and underlying malignancy. Hypoperfusion resulting from dialysis treatment has been identified in recent literature as a possible cause of AEN in patients with renal failure. This case adds to the growing body of literature highlighting AEN as a consequence of hemodialysis, and should be considered as a possible complication of dialysis patients who present with upper GI bleed.Figure 1Figure 2Figure 3" @default.
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• W2977774883 date "2015-10-01" @default.
• W2977774883 modified "2023-09-26" @default.
• W2977774883 title "Acute Esophageal Necrosis After Initiation of Hemodialysis in a Patient With Renal Failure" @default.
• W2977774883 doi "https://doi.org/10.14309/00000434-201510001-00557" @default.
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