Black Esophagus: Acute Esophageal Necrosis

A 93-year-old lady presented to the emergency department with nausea, hematemesis, and black stool. Laboratory analysis revealed hemoglobin of 9.3 g/dL. An esophagogastroduodenoscopy revealed the presence of circumferential black mucosa involving the full length of the esophagus with an abrupt arrest at the Z line and normal gastric and duodenal mucosa. Biopsies taken excluded malignancy or viral infection. Chest and abdominal CT scan confirmed a thickened esophagus with no signs of perforation or mediastinitis. The patient was treated with nil per os, intravenous fluids, and pantoprazole, to reduce the damage induced by acid reflux. She remained stable and repeat EGD 7 days after the admission showed esophageal mucosa fully recovered with no signs of necrosis nor even esophagitis. The patient was discharged home shortly after. Follow-up EGD at 6 months confirmed healing of the esophageal mucosa without stricture. The so-called black esophagus is a rare condition characterized by acute necrotizing ulceration usually limited to the distal third of the esophagus and probably due to ischemic hypoperfusion.