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Sachar M, Arguetta E, Gurvits GE. Comprehensive Review: Acute Esophageal Necrosis in the Setting of Gastric Volvulus. Dig Dis Sci 2023; 68:1672-1676. [PMID: 36961671 DOI: 10.1007/s10620-023-07869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND AIMS Acute esophageal necrosis (AEN) in the setting of gastric volvulus is a rare condition with only a handful of cases reported. Volvulus may contribute to AEN by limiting tissue perfusion and promoting massive reflux of gastric contents on compromised esophageal mucosa. METHODS We reviewed 225 original articles, literature reviews, case series, brief reports, case reports, and discuss six total cases of co-occurring esophageal necrosis and gastric volvulus. RESULTS AND CONCLUSIONS We present the first comprehensive analysis of all reported cases in the literature to date and formulate management strategies for the co-occurrence of AEN and volvulus. Management of AEN should be directed at correcting underlying medical conditions, providing hemodynamic support, initiating nil-per-os restriction, and administering high-dose proton pump inhibitor therapy. Surgical intervention is typically reserved for cases of esophageal perforation with mediastinitis and abscess formation.
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Affiliation(s)
- Moniyka Sachar
- Department of Medicine, New York University Langone Medical Center, 247 E 28Th Street, New York, NY, 10016, USA.
| | - Erick Arguetta
- Division of Gastroenterology, Brown University, Providence, RI, USA
| | - Grigoriy E Gurvits
- Division of Gastroenterology, New York University Langone Medical Center, New York, NY, USA
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2
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Imaoka K, Harano M, Oshita K, Yano T, Kubota T, Yoshimitsu M, Nakano K, Idan H, Shiozaki S, Okajima M. Indocyanine green fluorescence imaging for subtotal esophagectomy due to esophageal stenosis after acute esophageal necrosis: a report of two cases. Clin J Gastroenterol 2021; 14:415-421. [PMID: 33481163 DOI: 10.1007/s12328-020-01326-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
Although esophageal stricture after acute esophageal necrosis (AEN) is often refractory to dilation therapy, there have been few reports of surgical intervention. We report two rare cases of successful subtotal esophagectomy and esophagogastrostomy for esophageal strictures after AEN using indocyanine green (ICG) fluorescence imaging. In case 1, emergent esophagogastroduodenoscopy (EGD) in a 56-year-old man with coffee-ground emesis revealed black esophageal mucosa in the middle to lower esophagus, indicating AEN. Despite conservative therapy, an esophageal stricture developed after 2 weeks. Repeated endoscopic balloon dilation (EBD) did not resolve the stenosis; esophagectomy was thus performed approximately 6 months after AEN onset. We evaluated the blood flow to the esophagus using ICG fluorescence imaging to determine the proximal surgical resection line. The postoperative course was uneventful. In case 2, an 81-year-old woman with upper gastrointestinal bleeding with hematemesis and chest pain was diagnosed with AEN by EGD and was treated with conservative therapy. An esophageal stricture developed after 3 weeks, and repeated EBD was ineffective. Approximately 2 months after AEN onset, she underwent esophagectomy using ICG fluorescence imaging. The postoperative course was uneventful. Considering that AEN is a blood flow disorder, ICG fluorescence imaging is a useful technology to prevent surgical morbidity.
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Affiliation(s)
- Kouki Imaoka
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Surgery, Akane-Foundation, Tsuchiya General Hospital, 3-30 Nakajimacho, Naka-ku, Hiroshima, 730-8655, Japan
| | - Masao Harano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
| | - Ko Oshita
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Takuya Yano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Tetsushi Kubota
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Kanyu Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Hitoshi Idan
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Shigehiro Shiozaki
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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3
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A RARE CAUSE OF UPPER GASTROINTESTINAL BLEEDING: ACUTE ESOPHAGEAL NECROSIS. Gastroenterol Nurs 2020; 43:107-109. [PMID: 31990880 DOI: 10.1097/sga.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Schizas D, Theochari NA, Mylonas KS, Kanavidis P, Spartalis E, Triantafyllou S, Economopoulos KP, Theodorou D, Liakakos T. Acute esophageal necrosis: A systematic review and pooled analysis. World J Gastrointest Surg 2020; 12:104-115. [PMID: 32218893 PMCID: PMC7061242 DOI: 10.4240/wjgs.v12.i3.104] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/02/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute esophageal necrosis (AEN) is a rare entity with multifactorial etiology, usually presenting with signs of upper gastrointestinal bleeding.
AIM To systematically review all available data on demographics, clinical features, outcomes and management of this medical condition.
METHODS A systematic literature search was performed with respect to the PRISMA statement (end-of-search date: October 24, 2018). Data on the study design, interventions, participants and outcomes were extracted by two independent reviewers.
RESULTS Seventy-nine studies were included in this review. Overall, 114 patients with AEN were identified, of whom 83 were males and 31 females. Mean patient age was 62.1 ± 16.1. The most common presenting symptoms were melena, hematemesis or other manifestations of gastric bleeding (85%). The lower esophagus was most commonly involved (92.9%). The most widely implemented treatment modality was conservative treatment (75.4%), while surgical or endoscopic intervention was required in 24.6% of the cases. Mean overall follow-up was 66.2 ± 101.8 d. Overall 29.9% of patients died either during the initial hospital stay or during the follow-up period. Gastrointestinal symptoms on presentation [Odds ratio 3.50 (1.09-11.30), P = 0.03] and need for surgical or endoscopic treatment [surgical: Odds ratio 1.25 (1.03-1.51), P = 0.02; endoscopic: Odds ratio 1.4 (1.17-1.66), P < 0.01] were associated with increased odds of complications. A sub-analysis separating early versus late cases (after 2006) revealed a significantly increased frequency of surgical or endoscopic intervention (9.7 % vs 30.1% respectively, P = 0.04)
CONCLUSION AEN is a rare condition with controversial pathogenesis and unclear optimal management. Although the frequency of surgical and endoscopic intervention has increased in recent years, outcomes have remained the same. Therefore, further research work is needed to better understand how to best treat this potentially lethal disease.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
- Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece
| | - Nikoletta A Theochari
- Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece
| | - Konstantinos S Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
- Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Prodromos Kanavidis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Stamatina Triantafyllou
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens 11527, Greece
| | - Konstantinos P Economopoulos
- Department of Medicine, Surgery Working Group, Society of Junior Doctors, Athens 15122, Greece
- Department of Surgery, Duke University Medical Center, Durham, NC 27708, United States
| | - Dimitrios Theodorou
- First Propedeutic Department of Surgery, National and Kapodistrian University of Athens, Hippocration General Hospital, Athens 11527, Greece
| | - Theodore Liakakos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens 11527, Greece
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Ghoneim S, Shah A, Dalal S, Landsman M, Kyprianou A. Black Esophagus in the Setting of Diabetic Ketoacidosis: A Rare Finding from Our Institution. Case Rep Gastroenterol 2019; 13:475-480. [PMID: 31824236 DOI: 10.1159/000504434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/29/2019] [Indexed: 12/20/2022] Open
Abstract
Acute esophageal necrosis (AEN) is defined as necrosis of the esophageal mucosa seen as diffuse black discoloration of the distal esophagus on an upper endoscopy. The prevalence of the disease is rare and reported to be up to 0.2% in autopsy series. The etiology of the disease is thought to be multifactorial and due to ischemic insults to the esophagus with gastric acid reflux further damaging the vulnerable mucosa. Patients are often critically ill or with significant comorbidities. Here, we present a case series of 3 patients with AEN induced by diabetic ketoacidosis.
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Affiliation(s)
- Sara Ghoneim
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Aun Shah
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Shaman Dalal
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Marc Landsman
- Division of Gastroenterology and Hepatology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Annette Kyprianou
- Division of Gastroenterology and Hepatology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio, USA
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Abdullah HM, Ullah W, Abdallah M, Khan U, Hurairah A, Atiq M. Clinical presentations, management, and outcomes of acute esophageal necrosis: a systemic review. Expert Rev Gastroenterol Hepatol 2019; 13:507-514. [PMID: 30933549 DOI: 10.1080/17474124.2019.1601555] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To review all the reported literature on acute esophageal necrosis. RESEARCH METHODS Databases were searched using the special Medical Subject Heading (MeSH) terms. All the available reported cases of acute esophageal necrosis were analyzed. RESULTS A total of 154 cases were identified and 130 cases were analyzed. The mean age of presentation was 61 years, and 70% of cases were males. The most common presenting symptoms were hematemesis in 66%, shock in 36%, melena in 33%, abdominal or substernal pain in 28%. The most common comorbidities reported were diabetes in 38%, hypertension in 37%, alcohol abuse in 25%, and chronic kidney disease in 16%. On upper endoscopy, 51% had a distal disease, 36% had pan esophageal, and only 2% had a proximal disease. 84% of patients were treated with IV Proton Pump Inhibitors, 22% received transfusions, 23% got antibiotics for underlying sepsis, 14% also received sucralfate, and 4% required surgery for treatment. The mortality rate was 32%, while perforation was reported in 5% and stricture formation reported in 9% of patients. CONCLUSIONS Patients with acute esophageal necrosis can have a favorable outcome if treated appropriately.
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Affiliation(s)
| | - Waqas Ullah
- b Abington Hospital - Jefferson Health , Abington , PA , USA
| | - Mohamed Abdallah
- a Sanford School of Medicine , University of South Dakota , Sioux Falls , SD , USA
| | - Uzma Khan
- c Khyber Teaching Hospital , Peshawar , Pakistan
| | | | - Muslim Atiq
- a Sanford School of Medicine , University of South Dakota , Sioux Falls , SD , USA
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Ullah W, Mehmood A, Micaily I, Khan MS. Comprehensive review of acute oesophageal necrosis. BMJ Case Rep 2019; 12:e227967. [PMID: 30814100 PMCID: PMC6398709 DOI: 10.1136/bcr-2018-227967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2019] [Indexed: 10/27/2022] Open
Abstract
Acute oesophageal necrosis, also known as 'black oesophagus', is a rare condition characterised by the black discolouration of the oesophageal mucosa on endoscopy and involves the distal oesophagus in majority of cases but may also extend proximally. A number of conditions are found to be associated with it and it is thought to occur due to a combination of hypovolaemia and inadequate oesophageal protective mucosal barrier function. Gastric secretions may have a direct effect on the oesophageal mucosa. We present a case of a woman who presented with haematemesis and significant hypotension after a session of haemodialysis. Black oesophagus was confirmed on esophagogastroduodenoscopy. She was given two units of packed red blood cells and one unit of platelets, and started on a pantoprazole infusion. However, despite rigorous attempts at resuscitation the patient failed to recover.
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Affiliation(s)
- Waqas Ullah
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
| | - Asif Mehmood
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
| | - Ida Micaily
- Department of Internal Medicine, Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
| | - Muhammad Saeed Khan
- Department of Medicine, THQ Hospital Talash, Lower Dir, Khyber Pakhtunkhwa, Pakistan
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Marinucci C, Zardo F, Musso A, Strignano P, di Cella SM, Porta M. A severe case of epigastric pain, diarrhea and coffee ground vomitus. Intern Emerg Med 2018. [PMID: 29516431 DOI: 10.1007/s11739-018-1807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Federica Zardo
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alessandro Musso
- Department of Gastroenterology, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Strignano
- Department of General Surgery, Città della Salute e della Scienza di Torino, Corso AM Dogliotti 14, 10126, Turin, Italy
| | | | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy.
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Iwuji K, Jaroudi S, Bansal A, Rivas AM. Acute necrotizing esophagitis presenting with severe lactic acidosis and shock. Proc (Bayl Univ Med Cent) 2018; 31:457-459. [PMID: 30948978 DOI: 10.1080/08998280.2018.1488494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 02/02/2023] Open
Abstract
Acute necrotizing esophagitis, also known as "black esophagus," is typically characterized by a circumferential, friable black mucosal surface and preferentially involves the distal esophagus. It predominantly affects elderly men and presents as an upper gastrointestinal bleed. We describe a 60-year-old man with an acute upper gastrointestinal bleed and sepsis and subsequently acute necrotizing esophagitis.
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Affiliation(s)
- Kenneth Iwuji
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Sarah Jaroudi
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Arpana Bansal
- School of Medicine, Texas Tech University Health Sciences CenterLubbockTexas
| | - Ana Marcella Rivas
- Department of Internal Medicine, Texas Tech University Health Sciences CenterLubbockTexas
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10
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Abstract
Acute esophageal necrosis (AEN) is a particularly rare syndrome with an incidence of only 0.1-0.28%, whose appearance is notable for proximal extensions of black, necrotic appearing mucosa extending proximally in the esophagus and abruptly interrupted at the gastroesophageal junction. In this case series, we explore the cases of two males: one middle-aged and one elderly, who after presenting with emesis, were found to have acute esophageal necrosis on esophagogastroduodenoscopy.
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