Circumferential black discoloration of the esophagus that sharply demarcates the gastroesophageal junction is characteristic of acute esophageal necrosis (AEN). Also known as “black esophagus,” AEN results from a combination of ischemic injury, corrosive damage from gastric reflux, and impaired mucosal defenses, often in the setting of malnutrition — risk factors that were all present in the patient in this case. The distal esophagus is particularly vulnerable to ischemia given its watershed blood supply. Commonly associated conditions include diabetes, hypertension, and alcohol use disorder. Although rare, AEN carries substantial morbidity and mortality — so the stakes are high.
Comment
Circumferential black discoloration of the esophagus that sharply demarcates the gastroesophageal junction is characteristic of acute esophageal necrosis (AEN). Also known as “black esophagus,” AEN results from a combination of ischemic injury, corrosive damage from gastric reflux, and impaired mucosal defenses, often in the setting of malnutrition — risk factors that were all present in the patient in this case. The distal esophagus is particularly vulnerable to ischemia given its watershed blood supply. Commonly associated conditions include diabetes, hypertension, and alcohol use disorder. Although rare, AEN carries substantial morbidity and mortality — so the stakes are high.