Acute esophageal necrosis
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Acute esophageal necrosis, sometimes known as black esophagus or esophageal stroke is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis.
On endoscopy there is distal diffuse circumferential blackening of the esophageal mucosa that stops abruptly at the gastro-esophageal junction.
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Epidemiology
It is rare with <150 cases reported in the literature up until 2024 1. There is a greater male predilection 5.
Pathology
It can have a multifactorial etiology.
Location
The distal third of the esophagus is thought to be most commonly affected (97% of cases) due to poor vascularity.
Treatment and prognosis
It generally carries a poor prognosis 3,5 and presents with life-threatening upper gastrointestinal hemorrhage. Most cases are conservatively managed 3. It may lead to esophageal perforation.
History and etymology
It is thought to have been been first reported in 1990 and was then classified as a separate syndrome in 2007.
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