Acute oesophageal necrosis, sometimes known as Black oesophagus or oesophageal stroke, is a rare entity characterised by patchy or diffuse circumferential black pigmentation of the oesophageal mucosa from ischaemic necrosis.
It is classically characterised by a striking endoscopic image of diffuse, circumferential, black-appearing, distal oesophageal mucosa on oesophago-gastroduodenoscopy (OGD) that stops abruptly at the gastro-oesophageal junction.
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Epidemiology
It reported incidence is difficult to accurately determine but from total reported number of cases in the current literature of <150 1. There is a greater male predilection 5.
Pathology
It can have a multifactorial aetiology.
Location - distribution
The distal third of the oesophagus 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 present with life-threatening upper gastrointestinal haemorrhage. Most cases are conservatively managed 3. It may lead to oesophageal 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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