Author ORCID Identifier
0000-0002-2973-6463
Abstract
Introduction:
Acute esophageal necrosis (AEN), is a rare disorder with an estimated incidence of 0.01-0.28%. It typically affects the distal third of the esophagus. Approximately 90% of patients with acute esophageal necrosis present with upper gastrointestinal (GI) bleeding, primarily due to ischemic insult or severe hemodynamic compromise. In this report, we describe a case in which the patient presented with odynophagia and dysphagia, but without upper GI bleeding. The patient exhibited pan mucosal involvement of the esophagus, which extended to the gastric antrum.
Case: A 55-year-old man with a history of type 2 diabetes mellitus and substance abuse presented with intractable nausea and vomiting, leading to hospitalization for hypovolemic shock secondary to diabetic ketoacidosis (DKA). Following the resolution of DKA, he experienced worsening dysphagia and odynophagia. A barium swallow of the esophagus revealed a distal esophageal stricture. Upper endoscopy revealed marked hyperpigmentation, extensive sloughing, and mucosal friability involving the entire esophageal mucosa. Diffuse erythema, sloughing, and mucosal friability extended from the fundus to the antrum of the stomach, accompanied by mild pyloric stenosis and food retention. The patient was diagnosed with acute esophageal necrosis and marked acid reflux due to gastric hypomotility.
Treatment included intravenous proton pump inhibitors and total parenteral nutrition for two weeks. A follow-up upper endoscopy showed healing esophagitis and duodenitis, with the presence of moderate-sized clean based duodenal ulcers. The patient was maintained on a high dose of pantoprazole for a total of eight weeks.
Discussion: In contrast to the typical presentation of upper gastrointestinal (GI) bleeding in acute esophageal necrosis (AEN), our patient exhibited symptoms of vomiting, dysphagia, and odynophagia. Endoscopically, we observed diffuse pan esophageal necrosis and diffuse involvement of the gastric mucosa, which differed from the expected restriction to the distal esophagus with a distinct demarcation at the gastroesophageal junction (GEJ). Consequently, our case emphasizes the importance of considering AEN as a potential diagnosis in critically ill patients who present with complaints of dysphagia and odynophagia, even in the absence of upper GI bleeding. The atypical presentation and endoscopic findings observed in our patient warrant further investigation through additional studies to enhance our understanding of AEN.
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Recommended Citation
Shehadah A, Orakzai AA, Malik S, Yousef A, Jaan A, Okolo P. Anomalous Presentation and Endoscopic Findings of Acute Esophageal Necrosis: A Case Report. Advances in Clinical Medical Research and Healthcare Delivery. 2024; 4(2). doi: 10.53785/2769-2779.1201.