Black esophagus

Abstract

A 76-year-old male with multiple cardiovascular risk factors (hypertension, type 2 diabetes mellitus, LD, smoker) and severe peripheral arterial disease (iliofemoral bypass, supracondylar amputation) presented to the Emergency Ward with coffee ground emesis and mild anemia. Urgent gastroscopy showed diffuse circumferential black mucosa covered by fibrin, affecting the middle third and distal esophagus. These changes progressively worsened from the proximal to distal esophagus, until reaching the esophagogastric junction (EGJ), where they ended abruptly. Small superficial ulcers were also observed in the duodenum. The endoscopic findings along with the medical history suggested acute esophageal necrosis. The patient was treated with double-dose proton pump inhibitors (PPIs), with complete healing of the mucosa in a subsequent gastroscopy.