The Black Esophagus: A Rare Case Presentation

Acute esophageal necrosis (AEN), also known as black esophagus or Gurvits syndrome, is an uncommon endoscopic finding characterized by diffuse, circumferential, black discoloration of the esophagus that terminates at the gastroesophageal junction. The incidence of AEN has been reported to be 0-0.2% in autopsy series and up to 0.2% in observational studies. More common in elderly men, AEN usually presents with signs of upper gastrointestinal bleeding, such as hematemesis and melena, and is diagnosed by upper endoscopy. In severe cases, it can cause hemorrhagic shock, esophageal perforation, and mediastinitis. We present the case of a 78-year-old male with a history of diabetes mellitus, coronary artery disease, and peripheral arterial disease who presented with abdominal pain, obstipation, and vomiting for four days. He was found to have a small bowel obstruction secondary to incarcerated inguinal hernia and underwent hernia repair. The postoperative course was complicated by gastrointestinal bleeding requiring endoscopic examination, which revealed black discoloration of the esophagus, confirming the diagnosis of AEN. Management included aggressive fluid resuscitation, proton pump inhibitors, and nutritional support. Endoscopic interventions were performed to control bleeding. Physicians need to have a high index of suspicion for AEN in elderly patients with upper gastrointestinal bleeding due to the increased incidence in this age group. Early diagnosis and management can prevent complications and improve outcomes.