Journal of

Case Reports and Images in Medicine

 
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Case Report
 
Acute esophageal necrosis: Black esophagus in setting of diabetic ketoacidosis
Brooke Colin Bear1, Jacob Mathew1, Calvin W. Parker III2
1Resident Physician, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA.
2Gastroenterologist, Department of Medicine, Tripler Army Medical Center, Honolulu, HI, USA.

Article ID: 100005Z09BB2015
doi:10.5348/Z09-2015-5-CR-5

Address correspondence to:
Brooke Colin Bear
1 Jarrett White Road, Honolulu
HI USA
Phone: 96859-5000, 808-433-6641
Fax: 808-433-1556

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How to cite this article:
Bear BC, Mathew J, Parker III CW. Acute esophageal necrosis: Black esophagus in setting of diabetic ketoacidosis. J Case Rep Images Med 2015;1:18–21.


Abstract
Introduction: Acute esophageal necrosis (AEN) is a rare cause of upper gastrointestinal bleeding with an unclear etiology that may be related to ischemic insults resulting in caustic injury primarily to the distal segment of the esophagus along with damage caused by underlying coronary artery disease or diabetes mellitus. If not diagnosed correctly, treatment may incorrectly focus on proton pump rather than underlying medical conditions which if not addressed, can lead to repeat episodes of the condition.
Case Report: We report a case in which a patient presented in diabetic crises. Esophagogastroduodenoscopy (EGD) revealed circumferential necrotic discoloration and friable tissue of the gastroesophageal junction with a normal appearing stomach. Treatment with a proton pump inhibitor and aggressive insulin management led to cessation of symptoms.
Conclusion: Upper gastrointestinal bleeding is a common complaint in both the inpatient and outpatient settings. While many cases may be related to bacterial infection (Helicobacter pylori) or iatrogenic insults (NSAID or alcohol use), rare cases may be related to poorly controlled underlying medical conditions such as coronary artery disease or diabetes. Our case highlights the need to keep heightened suspicion for entities such as AEN in patients who have appropriate underlying medical conditions to prevent further episodes.

Keywords: Diabetic ketoacidosis, Endoscopy, Esophageal necrosis, Gastrointestinal bleed


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Author Contributions
Brooke Colin Bear – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Final approval of the version to be published
Jacob Mathew – Substantial contributions to conception and design, Acquisition of data, Drafting the article, Critical revision of the article, Final approval of the version to be published
Calvin W. Parker III – Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Brooke Colin Bear et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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