DOI: https://doi.org/10.36347/sjmcr.2026.v14i03.041

Pages: 487-490

Acute esophageal necrosis (AEN), also known as “black esophagus,” is a rare but life-threatening condition characterized by diffuse circumferential black discoloration of the esophageal mucosa with a sharp demarcation at the gastroesophageal junction. It is typically associated with severe systemic illness and multiple comorbidities. We report the case of a 77-year-old male with diabetes mellitus and arterial hypertension who was admitted for critical lower limb ischemia requiring surgical amputation. Two weeks later, he developed recurrent vomiting and hematemesis with a significant drop in hemoglobin levels. Urgent upper gastrointestinal endoscopy revealed extensive circumferential black mucosal necrosis involving the entire esophagus, abruptly ending at the esophagogastric junction, along with associated gastric and duodenal lesions. The patient received intensive supportive management including fluid resuscitation, blood transfusion, high-dose proton pump inhibitors, antibiotics, and correction of metabolic disturbances. Despite initial stabilization and adequate glycemic control, the clinical course was complicated by septic shock leading to death within five days. AEN is believed to result from a multifactorial pathophysiological process involving ischemic injury, impaired mucosal defenses, and gastric acid reflux. It predominantly affects elderly patients with significant comorbidities and commonly presents with upper gastrointestinal bleeding. Diagnosis relies on endoscopic findings, while management is mainly supportive and directed at correcting underlying conditions. The prognosis remains poor, with high mortality rates largely driven by the severity of associated systemic disorders. This case highlights the importance of early recognition of AEN in critically ill patients and underscores its severe prognosis despite appropriate management.