A case of coffee-ground emesis in an elderly patient

Authors

  • Giovanni D. De Palma,

    Corresponding author
    1. Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
    2. Center of Excellence for Technical Innovation in Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
    • Correspondence

      Giovanni D. De Palma, Center of Excellence for Technical Innovation in Surgery, School of Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Napoli, Italia. Tel: +39-081-7462773; Fax: +39-081-7462752; E-mail: giovanni.depalma@unina.it

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  • Marcello Persico,

    1. Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
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  • Pietro Forestieri

    1. Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
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Key Clinical Message

Black esophagus is an exceeding rare disorder with a multifactorial etiology. Clinical presentation is generally related to upper gastrointestinal bleeding. Diagnosis is based on endoscopic images. Overall mortality is largely related to the underlying medical condition.

Question

An 82-year-old man was admitted with a 2-day history of coffee-ground emesis. His medical history included coronary artery disease, hypertension, and diabetes mellitus. Urgent esophagogastroduodenoscopy showed circumferential, friable, black colored mucosa that extended at whole length of the esophagus and abruptly stopped at the esophagogastric junction (Fig. 1).

Figure 1.

Endoscopic view showing circumferential, friable, black colored mucosa.

What is the diagnosis?

Diagnosis

Acute necrotizing esophagitis (AEN: black esophagus). AEN is an uncommon condition with a multifactorial etiology. Male gender, older age, chronic medical conditions, including diabetes mellitus, and cardiovascular compromise, are considered as the main factors for developing AEN. The most common presenting symptom is acute upper gastrointestinal bleeding. Diagnosis of AEN is based on endoscopic images. Therapy includes intravenous proton pump inhibitor in high doses, twice a day, adequate hydration, short-term parenteral nutrition, nil per os, and the specific management of underlying disease.

Conflict of Interest

None declared.

Ancillary