2018년 7월 3일 화요일

Black esophagus. Acute esophageal necrosis (AEN)

Black esophagus or acute esophageal necrosis (AEN) is a striking medical condition characterized by circumferential black appearing esophageal mucosa affecting various lengths of the organ with nearly universal involvement of the distal esophagus and abrupt transition at the gastroesophageal junction (Dig Dis Sci. 2015). The etiological factor involved seems to be ischemic injury caused by arteriolosclerosis, arterial thrombosis, or aortic dissection.

Acute esophageal necrosis (= black esophagus)는 중증 전신 질환을 가진 환자에서 아마도 허혈성으로 발생하는 심한 급성 궤사성 질환입니다. 이름처럼 식도가 까맣게 보입니다. 2015년 international case series가 발표된 바 있습니다 (Dig Dis Sci. 2015).

"AEN is more common in geriatric males and characteristically (88 %) presents with signs of upper gastrointestinal hemorrhage. Risk factors include alcohol abuse, hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, malnourishment, and vascular disease. Hypoalbuminemia was universal, while anemia, renal insufficiency, and hyperglycemia were seen in nearly 90 % of the patients. Endoscopically, distal esophageal involvement with various proximal extension and sharp demarcation at the GE junction was seen in all patients. Duodenal pathology was seen in 50 % of the cases. Causes of AEN were largely multifactorial with all patients affected by a combination of ischemic insult, compromised mucosal defenses, and corrosive reflux injury of gastric contents. Treatment with acid suppression and correction of underlying medical conditions was implemented in all patients. Esophageal stricture formation was seen in 25 % of the patients and was associated with concurrent duodenal pathology. Mortality was 12.5 % and unrelated to AEN."

 Dig Dis Sci. 2015

워낙 충격적인 모양새인지라 학회 포스터로 발표되는 예가 많습니다.

 Acute esophageal necrosis (AEN), also known as "black esophagus" is characterized by a striking circumferential black appearance of esophageal mucosa on endoscop. AEN is a rare and is almost invariably associated with severe clinical conditions and serious comorbidities. (KDDW 2017. 가톨릭대)

 Black esophagus (KDDW 2017. 영남대)

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