Acute esophageal necrosis (AEN) or “black esophagus” is a rare clinical entity caused by necrosis of distal esophageal mucosa stemming from esophageal ischemia. Possible etiologies are broad but most commonly include possible triggers of low-flow vascular states in the esophagus, including infections, broad-spectrum antibiotic use, and gastric volvulus, among others. Patients most commonly present clinically with acute onset hematemesis and melena. Here, we describe a patient who initially presented with multiple nonspecific gastrointestinal symptoms, including abdominal pain and nausea, that progressed over a 10-day period, culminating in multiple episodes of hematemesis prior to presentation. Endoscopic evaluation confirmed the diagnosis of AEN and unveiled a possible paraesophageal hernia (PEH) as the causative factor. A subsequent videofluoroscopic barium swallow was utilized to better characterize the upper gastrointestinal anatomy and confirmed the PEH as a likely etiology. Esophagogastroduodenoscopy (EGD) can often identify PEH independently, but in patients with AEN secondary to a possible, but unclear, PEH on EGD, a videofluoroscopic barium swallow is an appropriate and useful next step in confirming the diagnosis. While treatment of AEN traditionally involves fluid resuscitation, intravenous protein pump inhibitors, and total parenteral nutrition, surgical intervention is often indicated in patients who have a contributing and symptomatic PEH.
Case Rep Gastroenterol 2021;15:594–597

中文翻译：

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继发于食管旁疝的急性食管坏死

急性食管坏死 (AEN) 或“黑色食管”是一种罕见的临床实体，由食管缺血引起的远端食管黏膜坏死引起。可能的病因很广泛，但最常见的原因包括食道中低流量血管状态的可能诱因，包括感染、广谱抗生素使用和胃扭转等。患者最常见的临床表现是急性发作性呕血和黑便。在这里，我们描述了一名患者，该患者最初出现多种非特异性胃肠道症状，包括腹痛和恶心，并在 10 天内进展，最终在就诊前出现多次呕血。内镜评估证实了 AEN 的诊断，并揭示了可能的食管旁疝 (PEH) 作为致病因素。随后的视频透视钡剂吞咽被用来更好地表征上消化道解剖结构，并确认 PEH 为可能的病因。食管胃十二指肠镜检查 (EGD) 通常可以独立识别 PEH，但对于继发于 EGD 上可能但不清楚的 PEH 的 AEN 患者，视频透视钡剂吞咽是确认诊断的合适且有用的下一步。虽然 AEN 的治疗传统上包括液体复苏、静脉内蛋白泵抑制剂和全胃肠外营养，但对有贡献和有症状的 PEH 的患者通常需要手术干预。但对于继发于 EGD 上可能但不清楚的 PEH 的 AEN 患者，视频透视钡剂吞咽是确认诊断的适当且有用的下一步。虽然 AEN 的治疗传统上包括液体复苏、静脉内蛋白泵抑制剂和全胃肠外营养，但对有贡献和有症状的 PEH 的患者通常需要手术干预。但对于继发于 EGD 上可能但不清楚的 PEH 的 AEN 患者，视频透视钡剂吞咽是确认诊断的适当且有用的下一步。虽然 AEN 的治疗传统上包括液体复苏、静脉内蛋白泵抑制剂和全胃肠外营养，但对有贡献和有症状的 PEH 的患者通常需要手术干预。
Case Rep Gastroenterol 2021；15:594–597